Update on nuclear medicine in end-of-life care of infants and children: radionuclide perfusion studies in the determination of death by neurological criteria (DNC).

"Death by neurologic criteria" (DNC), a condition previously described as "brain death", accounts for approximately 21% of deaths in the pediatric intensive care unit (PICU). DNC is primarily a clinical assessment, defined by the irreversible cessation of all functions of the entire brain including the brainstem. When physical examination and apnea testing, the standard components of DNC assessment, cannot be completed in full, ancillary investigations are required to complement and complete the process. Amongst accepted ancillary tests, radionuclide perfusion studies exhibit some of the highest levels of accuracy in adult and pediatric populations and have been favored in recent clinical and imaging guidelines. The goal of this review is to discuss radionuclide perfusion studies performed as ancillary studies in the determination of DNC in children, highlighting recent research, physiologic differences in pediatric brain and skull development, and differences in performing and interpreting radionuclide ancillary studies in this population.