Health disparities among older adults following tropical cyclone exposure in Florida.

Tropical cyclones (TCs) pose a significant threat to human health, and research is needed to identify high-risk subpopulations. We investigated whether hospitalization risks from TCs in Florida (FL), United States, varied across individuals and communities. We modeled the associations between all storms in FL from 1999 to 2016 and over 3.5 million Medicare hospitalizations for respiratory (RD) and cardiovascular disease (CVD). We estimated the relative risk (RR), comparing hospitalizations during TC-periods (2 days before to 7 days after) to matched non-TC-periods. We then separately modeled the associations in relation to individual and community characteristics. TCs were associated with elevated risk of RD hospitalizations (RR: 4.37, 95% CI: 3.08, 6.19), but not CVD (RR: 1.04, 95% CI: 0.87, 1.24). There was limited evidence of modification by individual characteristics (age, sex, or Medicaid eligibility); however, risks were elevated in communities with higher poverty or lower homeownership (for CVD hospitalizations) and in denser or more urban communities (for RD hospitalizations). More research is needed to understand the potential mechanisms and causal pathways that might account for the observed differences in the association between tropical cyclones and hospitalizations across communities.

Development and validation of models to predict personal ventilation rate for air pollution research.

Air pollution intake represents the amount of pollution inhaled into the body and may be calculated by multiplying an individual's ventilation rate with the concentration of pollutant present in their breathing zone. Ventilation rate is difficult to measure directly, and methods for estimating ventilation rate (and intake) are lacking. Therefore, the goal of this work was to examine how well linear models using heart rate and other basic physiologic data can predict personal ventilation rate. We measured personal ventilation and heart rate among a panel of subjects (n = 36) while they conducted a series of specified routine tasks of varying exertion levels. From these data, 136 candidate models were identified using a series of variable transformation and selection algorithms. A second "free­living" validation study (n = 26) served as an independent validation dataset for these candidate models. The top­performing model, which included heart rate (Hr), resting heart rate (Hrest), age, sex, and hip circumference and interactions between sex with Hr, Hrest, age, and hip predicted ventilation rate (Ve) to within 11% and 33% for moderate (Ve = 45 L/min) and low (Ve = 15 L/min) intensity activities, respectively, based on the validation study. Many of the promising candidate models performed substantially worse under independent validation. Our results indicate that while measures of air pollution exposure and intake are highly correlated within tasks for a given individual, this correlation decreases substantially across tasks (i.e., as individuals go about a series of typical daily activities). This discordance between exposure and intake may influence exposure­response estimates in epidemiological studies. New air pollution studies should consider the trade­offs between the predictive ability of intake models and the error potentially introduced by not accounting for ventilation rate.

Avoided climate impacts of urban and rural heat and cold waves over the U.S. using large climate model ensembles for RCP8.5 and RCP4.5.

Previous studies examining future changes in heat/cold waves using climate model ensembles have been limited to grid cell-average quantities. Here, we make use of an urban parameterization in the Community Earth System Model (CESM) that represents the urban heat island effect, which can exacerbate extreme heat but may ameliorate extreme cold in urban relative to rural areas. Heat/cold wave characteristics are derived for U.S. regions from a bias-corrected CESM 30-member ensemble for climate outcomes driven by the RCP8.5 forcing scenario and a 15-member ensemble driven by RCP4.5. Significant differences are found between urban and grid cell-average heat/cold wave characteristics. Most notably, urban heat waves for 1981-2005 are more intense than grid cell-average by 2.1°C (southeast) to 4.6°C (southwest), while cold waves are less intense. We assess the avoided climate impacts of urban heat/cold waves in 2061-2080 when following the lower forcing scenario. Urban heat wave days per year increase from 6 in 1981-2005 to up to 92 (southeast) in RCP8.5. Following RCP4.5 reduces heat wave days by about 50%. Large avoided impacts are demonstrated for individual communities; e.g., the longest heat wave for Houston in RCP4.5 is 38 days while in RCP8.5 there is one heat wave per year that is longer than a month with some lasting the entire summer. Heat waves also start later in the season in RCP4.5 (earliest are in early May) than RCP8.5 (mid-April), compared to 1981-2005 (late May). In some communities, cold wave events decrease from 2 per year for 1981-2005 to one-in-five year events in RCP4.5 and one-in-ten year events in RCP8.5.

Cardiac adaptations in SCNT newborn cloned calves during the first month of life assessed by echocardiography.

The aim of this study was to compare cardiac morphology in newborn and month-old control and cloned calves. A total of 10 in vivo-derived (IVD) control (five Holstein, five Hereford) and seven cloned (five Holstein, two Hereford) calves were subjected to echocardiographic examination, including 2D, M-mode, spectral and color flow Doppler evaluation at Day 1 (mean 26.3 h) and Day 30 (mean 29.2 days) after birth. Echocardiographic measurements were compared between control and cloned calves, and between Hereford and Holstein control calves of the same age. At Day 1 and at Day 30 after birth, left ventricular free wall (LVFW) and interventricular septal (IVS) thicknesses were greater in Holstein calves than Hereford calves. Several indices of myocardial wall thickness were increased in cloned versus control calves at Day 1 after birth, and included systolic LVFW thickness, systolic right ventricular free wall (RVFW) thickness, diastolic LVFW thickness, diastolic RVFW thickness and diastolic IVS thickness (p < 0.05). Differences between cloned and non-cloned calves were no longer evident at Day 30 after birth. The apparent disappearance of the cloning effect on cardiac structures may reflect the influence of placenta on fetal cardiac morphology, suggestive of a placental hemodynamic role in fetal cardiac muscle development. Differences seen in clones at birth spontaneously resolved by Day 30 of age, after organ development recovery from cardiovascular abnormalities of presumed placental origin. Echocardiographic measurements should provide useful data for research and clinical evaluation of high-risk neonatal calves of both breeds and from clones of the same breed.

Vitamin D status and recurrent preterm birth: a nested case-control study in high-risk women.

OBJECTIVE: To determine whether vitamin D status is associated with recurrent preterm birth, and any interactions between vitamin D levels and fish consumption. DESIGN: A nested case-control study, using data from a randomised trial of omega-3 fatty acid supplementation to prevent recurrent preterm birth. SETTING: Fourteen academic health centres in the USA. POPULATION: Women with prior spontaneous preterm birth. METHODS: In 131 cases (preterm delivery at <35 weeks of gestation) and 134 term controls, we measured serum 25-hydroxyvitamin D [25(OH)D] concentrations by liquid chromatography-tandem mass spectrometry (LC-MS) from samples collected at baseline (16-22 weeks of gestation). Logistic regression models controlled for study centre, maternal age, race/ethnicity, number of prior preterm deliveries, smoking status, body mass index, and treatment. MAIN OUTCOME MEASURES: Recurrent preterm birth at <37 and <32 weeks of gestation. RESULTS: The median mid-gestation serum 25(OH)D concentration was 67 nmol/l, and 27% had concentrations of <50 nmol/l. Serum 25(OH)D concentration was not significantly associated with preterm birth (OR 1.33; 95% CI 0.48-3.70 for lowest versus highest quartiles). Likewise, comparing women with 25(OH)D concentrations of 50 nmol/l, or higher, with those with <50 nmol/l generated an odds ratio of 0.80 (95% CI 0.38-1.69). Contrary to our expectation, a negative correlation was observed between fish consumption and serum 25(OH)D concentration (-0.18, P < 0.01). CONCLUSIONS: In a cohort of women with a prior preterm birth, vitamin D status at mid-pregnancy was not associated with recurrent preterm birth.

Relationship between disc injury and manual lifting: a poroelastic finite element model study.

Understanding how failure originates in a lumbar motion segment subjected to loading conditions that are representative of manual lifting is important because it will pave the way for a better formulation of the exposure-injury relationship. The aim of the current investigation was to use a poroelastic finite element model of a human lumbar disc to determine its biomechanical characteristics under loading conditions that corresponded to three different, commonly occurring lifting activities and to identify the most hazardous type of loading with regard to damage to the disc. The current study showed that asymmetric lifting may increase the risk of back injury and pain. Lifting that involved lateral bending (asymmetric lifting) of the trunk was found to produce stresses at a localized area in the annulus, annuluar fibres, end plates, and facet joints that were higher than their respective tissue failure strength. Thus asymmetric lifting, if performed over a large number of cycles, might help to propagate this localized failure of the disc tissue to a larger area, owing to fatigue. The analyses also showed that largest fluid exchange between the nucleus and the end plates occurred during asymmetric lifting. If the fluid exchange is restricted owing to end plate calcification or sclerosis of the subchondral bone, high intradiscal pressure might develop, leading to higher disc bulge causing back pain.

Effect of porcine zonae pellucidae immunisation on ovarian follicular development and endocrine function in domestic ewes (Ovis aries).

Domestic ewes (Ovis aries) were immunised with porcine zonae pellucidae (pZP) or pZP conjugated to keyhole limpet haemocyanin (KLH) in adjuvant(s) to examine the feasibility of the species to serve as a model for further development of pZP-based vaccines in ungulates. Two immunisation groups were employed, with a third group receiving only adjuvant (n = 5 per group). Early in the study, oestrous activity was monitored by the use of a vasectomised ram fitted with a marking harness. Eventually, ewes were exposed to an intact ram for breeding. In addition, weekly serum and every-other-day faecal samples were collected to measure pZP antibodies and progesterone metabolite concentrations respectively. At the conclusion of the study, fecundity was established, and ovarian tissue was examined. Ewes immunised against pZP : KLH with adjuvant produced minimal antibody absorbance levels, displayed normal oestrous cycles, became pregnant upon introduction of the intact ram and exhibited normal ovarian histopathology. Ewes immunised against pZP with adjuvant produced high antibody absorbance levels, were acyclic following primary immunisation and were infertile. Examination of the ovarian tissue revealed atrophic changes that included: (1) the absence of growing follicles; (2) significant reduction in the number of primordial follicles; and (3) the presence of abnormal granulosa cell clusters lacking oocytes. Antisera displayed immunoreactivity to the major components of pZP, and immunohistochemical labelling of ovarian tissue showed specificity to the ZP. These data are the first generated in an ungulate species showing deleterious effects of pZP immunisation on folliculogenesis and oestrous cyclicity.

Production and processing of milk from transgenic goats expressing human lysozyme in the mammary gland.

The potential for applying biotechnology to benefit animal agriculture and food production has long been speculated. The addition of human milk components with intrinsic antimicrobial activity and positive charge to livestock milk by genetic engineering has the potential to benefit animal health, as well as food safety and production. We generated one line of transgenic goats as a model for the dairy cow designed to express human lysozyme in the mammary gland. Here we report the characterization of the milk from 5 transgenic females of this line expressing human lysozyme in their milk at 270 microg/mL or 68% of the level found in human milk. Milk from transgenic animals had a lower somatic cell count, but the overall component composition of the milk and milk production were not different from controls. Milk from transgenic animals had a shorter rennet clotting time and increased curd strength. Milk of such nature may be of benefit to the producer by influencing udder health and milk processing.

Hot topic: using a stearoyl-CoA desaturase transgene to alter milk fatty acid composition.

Stearoyl-CoA desaturase enzyme converts specific medium- and long-chain saturated fatty acids to their monounsaturated form. Transgenic goats expressing a bovine beta-lactoglobulin promoter-rat stearoyl-CoA desaturase cDNA construct in mammary gland epithelial cells were produced by pronuclear microinjection. The fatty acid composition of milk from 4 female transgenic founders was analyzed on d 7, 14, and 30 of their first lactation. In 2 animals, the expression of the transgene changed the overall fatty acid composition of the resulting milk fat to a less saturated and more monounsaturated fatty acid profile at d 7 of lactation; however, this effect diminished by d 30. In addition, one animal had an increased proportion of the rumen-derived monounsaturated fatty acid C18:1 trans11 converted by stearoyl-CoA desaturase to the conjugated linoleic acid isomer C18:2 cis9 trans11. Milk that has higher proportions of monounsaturated fatty acids and conjugated linoleic acid may have benefits for human cardiovascular health.

Evidence of increased substrate availability to in vitro-derived bovine foetuses and association with accelerated conceptus growth.

Changes in placental development have been associated with foetal abnormalities after in vitro embryo manipulations. This study was designed to investigate bovine conceptus development and substrate levels in plasma and fluids in in vivo- and in vitro-produced (IVP) concepti and neonates. In vivo-produced and IVP embryos were derived by established embryo production procedures. Pregnant animals from both groups were slaughtered on days 90 or 180 of gestation, or allowed to go to term. Conceptus and neonatal physical traits were recorded; foetal, maternal and neonatal blood, and foetal fluids were collected for the determination of blood and fluid chemistry, and glucose, fructose and lactate concentrations. Placental transcripts for specific glucose transporters were determined by quantitative RT-PCR. No significant differences in uterine and conceptus traits were observed between groups on day 90. On day 180, larger uterine, placental and foetal weights, and an increase in placental gross surface area (SA) in IVP pregnancies were associated with increased glucose and fructose accumulation in foetal plasma and associated fluids, with no differences in the expression of components of the glucose transporter system. Therefore, the enlarged placental SA in IVP pregnancies suggests an increase in substrate uptake and transport capacity. Newborn IVP calves displayed higher birth weights and plasma fructose concentrations soon after birth, findings which appeared to be associated with clinical and metabolic distress. Our results indicated larger concepti and increased placental fructogenic capacity in mid- to late IVP pregnancies, features which appeared to be associated with an enhanced substrate supply, potentially glucose, to the conceptus.

The placenta as a contributor to production of large calves.

Unusually high birth weights frequently occur in calves born from cultured bovine embryos. The mechanism(s) through which in vitro manipulations during early cleavage are translated to enhanced fetal growth is (are) incompletely understood. Accelerated growth is primarily prenatal, and the placenta of an in vitro-derived conceptus could account for abnormal fetal growth. Results from a systematic comparison of placental morphology and function in bovine concepti produced in vitro versus in vivo are discussed.

Contributions of tissues to expression of a major gene for growth in chimeric mice.

The objective of this research was to determine the effect of genotype of particular tissues and organs on the growth of a chimera produced by aggregating an embryo homozygous for the high-growth (hg) allele with an embryo from a control line of wild-type mice lacking the deletion responsible for the high-growth phenotype. A total of 107 chimeric mice were produced, 81 males and 26 females. The preponderance of male chimeras closely fit the expected 3:1 ratio of males to females in balanced chimeric populations, suggesting that neither of the two genetic lines appeared to have a selective advantage for contributions to chimeric tissues. No single correlation between individual tissue chimerism and mouse growth was remarkable relative to correlations of chimerism of other tissues to growth. Other statistical models, including multiple regression techniques, did nothing to identify particular organs, tissues or various combinations that improved the explanation of expression of the high-growth phenotype by percentage of high-growth cells in that organ. These observations suggest that the chromosomal deletion thought to cause the high-growth phenotype has a systemic effect, without dominant effects of or on individual organs or tissues; the precise mechanism has yet to be determined.

Hematopoietic stem cell transplantation in utero produces sheep-goat chimeras.

Both allogeneic and xenogeneic hematopoietic chimera models have been developed, including fetal sheep models that demonstrated high levels of stable, multilineage engraftment created by in utero hematopoietic stem cell transplantation. The aim of this study was to test the efficacy of in utero transplantation to create xenogeneic sheep-goat hematopoietic chimeras. Fetal liver cells and T-cell-depleted adult bone marrow were tested as sources of hematopoietic stem cells. Donor cells were injected intraperitoneally into 130 recipient fetuses between 49 and 62 days of gestation. Groups 1 and 2 received crude fetal liver cell preparations. Group 3 received fetal liver cells that were incubated overnight in a phytohemagglutinin-stimulated lymphocyte-conditioned medium (PHA-LCM). In Group 4, hematopoietic stem cells were concentrated by using additional density separations. Group 5 fetal recipients received low-density, T-cell-depleted adult bone marrow cells. In Group 1, fetuses were accessed via hysterotomy. Hematopoietic stem cells were injected into Groups 2, 3, 4, and 5 without cutting through the uterine wall. Fetal survival in the five groups ranged from 56 to 100%. The percentage of chimeras from injected fetuses ranged from 43 to 92% by FACS and PCR analyses; however, levels of chimerism were low (<1%). The highest rates of chimerism were found among recipients of low-density fetal liver cells. Despite the pre-immunocompetent status of the fetal recipients and the genetic similarities between sheep and goats, high levels of engraftment were not observed. The consistently low levels of chimerism observed in this study, as well as the poor results recently reported by others using these procedures, indicate that significant barriers exist to transplanting hematopoietic stem cells in utero.

Evidence against humoral immune attack as the cause of sheep-goat interspecies and hybrid pregnancy failure in the doe.

The failure of interspecies and hybrid pregnancies between the domestic sheep (Ovis aries) and goat (Capra hircus) is not completely understood. The sheep-goat hematopoietic chimera is a unique model for studying the role of the maternal immune response in failure of interspecies and hybrid pregnancies between these species. Hematopoietic chimeras were created by in utero transplantation of sheep fetal liver cells into goat fetuses. The resulting chimeric females were recipients of sheep demi-embryos genetically identical to their sheep cells and/or were bred to a ram to create a hybrid pregnancy. Pregnancy sera were analyzed for the presence of anti-species antibodies (Ab) using a lymphocyte microcytotoxicity assay. None of the concepti survived to term. Gross and histological evaluations of two interspecies sheep concepti revealed abnormal placentome formation. The humoral immune response of several hematopoietic chimeras to the challenging concepti differed from control animals. We observed delayed onset of Ab production, low and absent titers, and persistent Ab titers with delayed fetal death. Ultrasonography typically revealed normal fetal development associated with high volumes of placental fluids and retarded placentome development. We conclude that fetal death was associated with abnormal placental development that was not the result of maternal humoral immune attack.

Fetal leukocyte trafficking as a stimulus for the production of maternal antibodies in the goat.

The production of antibodies during pregnancy or after parturition is a natural occurrence in many mammalian species. Fetal cells have been detected in the peripheral blood of women and mice and are thought to be the immune stimulus for antibody production. The aim of this study was to investigate if the production of maternal anti-fetal antibodies during ruminant pregnancy is the result of fetal leukocyte trafficking across the placenta. Maternal pregnancy serum was collected from 94 does whose fetuses received sheep hematopoietic stem cells via in utero transplantation at 49 to 62 d of gestation. Serum samples were collected before surgery and at weekly intervals throughout gestation. A lymphocyte microcytotoxicity assay was used to screen the serum samples from does that carried chimeric fetuses to term (n = 75). Of these 75 does, 28 parous does had presurgery serum that contained alloreactive antibodies. Nine of the 75 does had nonreactive presurgery serum, but they produced alloreactive antibody titers during gestation. Xenoreactive antibodies were detected in the pregnancy sera from 2 of the 75 does tested. Hemolytic assays confirmed the species-specificity of the xenoreactive serum from these 2 does. In view of the fact that hematopoietic cells were the only source of anti-sheep antibody stimulation in this model, we propose that fetal leukocyte trafficking does take place across the caprine placenta.

Maternal-conceptus signalling during early pregnancy in mares: oestrogen and insulin-like growth factor I.

Embryonic production of oestrogen is thought to play an important role in conceptus-maternal signalling during early pregnancy in mares, and may be regulated in an autocrine or paracrine fashion by insulin-like growth factor I (IGF-I). In this study, the hypothesis that IGF-I stimulates embryonic oestrogen synthesis, which in turn stimulates uterine IGF-I secretion was tested. Specific sources of IGF-I in the uterine lumen were characterized. Preimplantation embryos, uterine biopsies, and uterine flush fluids were collected on day 13 of pregnancy. Embryos were cultured whole for 24 h, or dispersed and incubated in serum-free culture medium supplemented with androstenedione or testosterone (0-10 microg ml(-1)) and IGF-I (0-100 microg ml(-1)). Oestrogen synthesis was increased by addition of androgen, but there was no dose-dependent effect of IGF-I. Endometrial explants were cultured for 24, 48 and 72 h in serum-free medium supplemented with oestradiol. IGF-I was measured by radioimmunoassay in embryo-conditioned medium, explant culture medium, blastocoelic fluid, concentrated (x 100) uterine flush fluid and endometrial-tissue homogenate. Both the embryo and endometrium produced significant quantities of IGF-I, indicating a role for this growth factor in autocrine-paracrine signalling during early pregnancy. However, secretion of IGF-I by endometrial explants was not modulated by oestrogen.

Successful pregnancy in goats carrying their genetically identical conceptus.

Mammalian pregnancies are naturally allogeneic, but syngeneic pregnancies have been carried to term in laboratory animal species. The need for maternal immune recognition during mammalian pregnancy is still unclear. Allogeneic pregnancies are protected from maternal immune attack by the nature of the trophoblast and its interactions with maternal tissues at the maternal-fetal interface. Syngeneic pregnancy models and the success of pregnancies in immunosuppressed mice challenge the necessity of a maternal immune response in mammals. This study was designed to investigate if outbred, domestic sheep and goats can successfully establish and maintain a syngeneic pregnancy. Embryo splitting and cryopreservation techniques were used to enable sheep and goat demi-embryos to be transferred to genetically identical females. Allogeneic pregnancies were established from the transfer of demi-embryos subjected to the same manipulations to assess demi-embryo survival and pregnancy rates under conventional immune compatibility conditions. Syngeneic pregnancies were established and carried to term in goats (2/11) but not in sheep (0/24). Microsatellite and DNA fingerprinting analyses confirmed that each kid was a genetically identical twin to the female that carried it to term. Our results demonstrated that genetic disparity is not required for the establishment and maintenance of pregnancy in goats, but our results were inconclusive for sheep.

CT angiography for the detection and characterization of carotid artery bifurcation disease.

BACKGROUND AND PURPOSE: Computed tomographic angiography (CTA) is a relatively new and minimally invasive method of imaging intracranial and extracranial blood vessels. The main purpose of this study was to compare CTA to the current gold standard of arterial imaging, digital subtraction angiography (DSA), for the detection and quantification of carotid artery bifurcation stenosis. We also compared Doppler ultrasound (US) with these 2 techniques. METHODS: In a prospective study, 40 patients (80 carotid arteries) underwent CTA, US, and DSA. Patients chosen for inclusion were symptomatic with TIAs or stroke and had initial US screening that indicated >50% carotid stenosis on the side appropriate for the symptoms. Source axial, maximum intensity projection (MIP), and shaded-surface display (SSD) images were produced for each CTA study. The US, CTA, and DSA images were reviewed, with the degree of stenosis quantified and presence of ulcers determined; each type of imaging was reviewed by a separate investigator blinded to the results of the other 2 modalities. The results of CTA and US imaging were compared with the DSA images for degrees of carotid stenosis. RESULTS: CTA source axial images correlated with DSA more closely than MIP or SSD images for all degrees of stenosis. The correlation between US and DSA (0.808) was poorer than that between CTA and DSA (0.892 to 0.922). CTA performed well in the detection of mild (0% to 29%) carotid stenosis, as well as carotid occlusion, with values for sensitivity, specificity, and accuracy near 100%. In determining that a stenosis was >50% by DSA measurement, CTA was again useful, with a sensitivity, specificity, and accuracy of 89%, 91%, and 90%, respectively. While CTA was quite specific and accurate in identifying degrees of stenoses in either the 50% to 69% or the 70% to 99% ranges, in this task it was much less sensitive: 65% for 50%-69% stenosis and 73% for 70%-99% stenosis. These results did not change significantly when only the data from the most clinically relevant symptomatic arteries were analyzed. CTA was found to correlate quite well with DSA in the detection of ulcers associated with the carotid stenosis. CONCLUSIONS: CTA was found to be an excellent examination for the detection of carotid occlusion and categorization of stenosis in either the 0%-29% or >50% ranges. However, CTA was unable to reliably distinguish between moderate (50%-69%) and severe (70%-99%) stenosis, which is an important limitation in the investigation and treatment of carotid stenosis.

Effects of the high growth (hg) mutation on reproduction in high growth (HG) female mice.

Reproductive performance was characterized in females of a line of mice homozygous for a recessive mutation with a major effect on growth, the high growth (hg) mutation. Specifically, the age at onset of puberty, length of the estrous cycle, ovulation rate, and gestation length in high growth (HG) mice were determined and compared with control mice. HG females reached puberty at an age similar to control animals, exhibited normal ovulation rates and estrous cycle length, but had a shorter length of estrus. Number of fetuses at Day 17 of gestation was greater and gestation length was longer in HG females. The HG females exhibited a variety of reproductive disorders, including increased incidence of repeated detection of mating plugs without intervening pregnancy ("replug"), increased incidence of repeated detection of mating plugs within an interval of 1-8 days without intervening pregnancy ("recycle"), increased interval between pairing with a male and detection of the first mating plug, increased interval between mating and conception, increased postnatal mortality, decreased litter size, and increased incidence of vaginal septum.

CT angiography for the detection of cerebral vasospasm in patients with acute subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Digital subtraction angiography (DSA) is the standard of reference for detecting cerebral vasospasm after subarachnoid hemorrhage (SAH). CT angiography (CTA) is a relatively recent method for depicting the intracranial arterial vasculature. The purpose of this study was to compare CTA and DSA in the detection and quantification of cerebral vasospasm. METHODS: Seventeen patients with SAH underwent initial CTA with or without DSA and follow-up CTA and DSA. The follow-up CTA and DSA studies were performed within 24 hours of each other and 5 to 10 days after SAH. Maximum intensity projection images were produced for each CTA. Six arterial locations were examined for spasm: the suprasellar internal carotid artery (ICA), the M1 and M2 segments of the middle cerebral artery, the A1 and A2 segments of the anterior cerebral artery, and the basilar artery. Vasospasm was categorized as none, mild (<30% luminal reduction), moderate (30% to 50% reduction), or severe (>50% reduction). RESULTS: The overall correlation between CTA and DSA was 0.757, but was better for proximal than distal locations (0.88-1.00 versus 0.152-0.446). Agreement between CTA and DSA was greater for no spasm (92%) and severe spasm (100%) than for mild (57%) or moderate (64%) spasm. CTA was highly accurate for no spasm or severe spasm in proximal locations (96%, and 100%, respectively); it was less accurate (90% and 95%, respectively) for mild or moderate spasm in these locations. For distal locations, the accuracy for absent, mild, moderate, or severe spasm was 78%, 81%, 94%, and 100%, respectively. CONCLUSION: CTA is highly sensitive, specific, and accurate in detecting no spasm or severe cerebral vasospasm in proximal arterial locations; it is less accurate for detecting mild and moderate spasm in distal locations.