The "hot nose" sign on brain death nuclear scintigraphy: where does the flow really go?

Clin Nucl Med. 2008 Jan;33(1):55-7. doi: 10.1097/RLU.0b013e31815c4fbf.


Nuclear scintigraphy has been used in patients with brain death since the 1970s. Many studies report a "hot nose" sign as predictive of brain death and lack of cerebral flow. Current nuclear medicine textbooks state that increased flow to the nose occurs secondary to occlusion of the internal carotid artery with flow rerouted to the nose via the external carotid artery. This explanation has been provided for decades assuming that the blood flow is actually increased to the nose. We performed a study to determine whether flow is really seen in the nose when a hot nose sign is present.

MeSH terms

  • Brain Death / diagnostic imaging*
  • Humans
  • Nose / blood supply*
  • Nose / diagnostic imaging*
  • Predictive Value of Tests
  • Radionuclide Imaging
  • Radiopharmaceuticals
  • Technetium Tc 99m Exametazime


  • Radiopharmaceuticals
  • Technetium Tc 99m Exametazime