Neuroimaging on the Evaluation of Death by Neurological Criteria: A Systematic Review With Real‐Life Insights

Neuroimaging plays a crucial role in determining brain death or death by neurological criteria (DNC). It helps establish the cause of irreversible brain injury, and when the clinical brain death exam cannot be completed, it can confirm the diagnosis of DNC. These imaging modalities, also called ancillary tests, have been widely studied, with a few demonstrating high sensitivity and specificity with a zero false positive rate. Among the various imaging modalities available, only some are endorsed by international guidelines as ancillary tests for the determination of brain death. Transcranial Doppler (TCD), four‐vessel digital subtraction angiography (DSA), and nuclear brain tests are considered the most used methods. In this review, we highlight the main features of these recommended ancillary tests, discuss their strengths and limitations, and use clinical vignettes to illustrate key findings.