Quantitative angiographic blood-flow measurement using pulsed intra-arterial injection.

A technique for quantitative blood-flow measurement using a novel pulsed injection of radiographic contrast agent is reported. A pressurized source of contrast agent is interrupted by a rotary valve at rates ranging from 1 to 30 Hz, producing well-defined boli at the end of a catheter. The position of these boli can be recorded by a digital radiographic system and analyzed by one of several previously reported techniques, to produce quantitative measurements of blood velocity and flow rate throughout the cardiac cycle. The contrast-agent flow wave form produced by the pulsed injector has been measured with an electromagnetic flow meter, for driving pressures ranging from 600 to 1500 kPa. Excellent modulation of the contrast agent is observed for injection frequencies up to 20 Hz, through catheters up to 100 cm in length. Preliminary in vitro angiographic flow measurements have been performed using an x-ray image intensifier, coupled to a linear photodiode array as the digital detector. Both constant flow and pulsatile human blood-flow wave forms were simulated within a 6.4-mm-diam straight tube and monitored with an electromagnetic flow meter. These experiments indicate that the pulsed injector can be used to provide estimates of arterial blood flow over the entire cardiac cycle (including reverse flow), to within about +/-11%, following injection of less than 10 ml of iodinated contrast agent.     

The effect of (+)-tubocurarine chloride and of acute hypotension on electrocortical activity of the cat

1. The effects of I.V. injection of tubocurarine (3 mg/kg) and of acute hypotension upon electrocortical activity of cats under sodium pentobarbitone were analysed. Technical artifacts associated with changes in brain volume were minimized.2. Initially, the superficial cortical response was reduced by tubocurarine either insignificantly or by 34% or less. Cats bled before injection of tubocurarine showed initially a similar reduction but, occasionally, a severe delayed reduction was found. Any fall in the superficial cortical response started during the secondary rise in B.P., many seconds after the B.P. had reached its lowest initial level. By contrast, spontaneous electrocortical activity was reduced approximately when the peak initial fall of B.P. occurred and it started to recover during the secondary rise in B.P. Reduction of the superficial cortical response could still be elicited after spindling had been suppressed by deep barbiturate anaesthesia. The initial thalamocortical afferent component in somatosensory area I, which was evoked by dorsal column stimulation, was less reduced by injection of tubocurarine than were the post-synaptic positive-negative components.3. The depressant effects of injected tubocurarine upon the superficial cortical response and spindle activity were approximated by rapid arterial bleeding.4. The superficial cortical response was reduced following virtual arrest of the cerebral circulation by acute exsanguination or by acute oil embolization. Such reduction most likely does not depend on systemic transport of inhibitory substances to the brain.5. After injection of tubocurarine the rate of outflow from the superior sagittal sinus was variably reduced during the initial fall in B.P., and often showed a variable, secondary increase. A net deficit in cerebral blood flow was usually present during the period of 80 sec after injection.6. The variability in the effects of injected tubocurarine upon electrocortical activity is attributed to the variability of the net deficit in cerebral blood flow.     

Using flow information to support 3D vessel reconstruction from rotational angiography

For the assessment of cerebrovascular diseases, it is beneficial to obtain three-dimensional (3D) morphologic and hemodynamic information about the vessel system. Rotational angiography is routinely used to image the 3D vascular geometry and we have shown previously that rotational subtraction angiography has the potential to also give quantitative information about blood flow. Flow information can be determined when the angiographic sequence shows inflow and possibly outflow of contrast agent. However, a standard volume reconstruction assumes that the vessel tree is uniformly filled with contrast agent during the whole acquisition. If this is not the case, the reconstruction exhibits artifacts. Here, we show how flow information can be used to support the reconstruction of the 3D vessel centerline and radii in this case. Our method uses the fast marching algorithm to determine the order in which voxels are analyzed. For every voxel, the rotational time intensity curve (R-TIC) is determined from the image intensities at the projection points of the current voxel. Next, the bolus arrival time of the contrast agent at the voxel is estimated from the R-TIC. Then, a measure of the intensity and duration of the enhancement is determined, from which a speed value is calculated that steers the propagation of the fast marching algorithm. The results of the fast marching algorithm are used to determine the 3D centerline by backtracking. The 3D radius is reconstructed from 2D radius estimates on the projection images. The proposed method was tested on computer simulated rotational angiography sequences with systematically varied x-ray acquisition, blood flow, and contrast agent injection parameters and on datasets from an experimental setup using an anthropomorphic cerebrovascular phantom. For the computer simulation, the mean absolute error of the 3D centerline and 3D radius estimation was 0.42 and 0.25 mm, respectively. For the experimental datasets, the mean absolute error of the 3D centerline was 0.45 mm. Under pulsatile and nonpulsatile conditions, flow information can be used to enable a 3D vessel reconstruction from rotational angiography with inflow and possibly outflow of contrast agent. We found that the most important parameter for the quality of the reconstruction of centerline and radii is the range through which the x-ray system rotates in the time span of the injection. Good results were obtained if this range was at least 135 degrees. As a standard c-arm can rotate 205 degrees, typically one third of the acquisition can show inflow or outflow of contrast agent, which is required for the quantification of blood flow from rotational angiography.     

Myocardial blood flow quantification with MRI by model-independent deconvolution

Magnetic resonance (MR) imaging during the first pass of an injected contrast agent has been used to assess myocardial perfusion, but the quantification of blood flow has been generally judged as too complex for its clinical application. This study demonstrates the feasibility of applying model-independent deconvolution to the measured tissue residue curves to quantify myocardial perfusion. Model-independent approaches only require minimal user interaction or expertise in modeling. Monte Carlo simulations were performed with contrast-to-noise ratios typical of MR myocardial perfusion studies to determine the accuracy of the resulting blood flow estimates. With a B-spline representation of the tissue impulse response and Tikhonov regularization, the bias of blood flow estimates obtained by model-independent deconvolution was less than 1% in all cases for peak contrast to noise ratios in the range from 15:1 to 20:1. The relative dispersion of blood flow estimates in Monte Carlo simulations was less than 7%. Comparison of MR blood flow estimates against measurements with radio-isotope labeled microspheres indicated excellent linear correlation (R2 = 0.995, slope: 0.96, intercept: 0.06). It can be concluded from these studies that the application of myocardial blood flow quantification with MRI can be performed with model-independent methods, and this should support a more widespread use of blood flow quantification in the clinical environment.     

Effect of contrast agent viscosity and injection flow velocity on bolus injection pressures for peripheral venous injection in first-pass myocardial perfusion studies.

Myocardial perfusion imaging using Gd contrast agents is typically performed with bolus injections of the contrast agent using a power injector to provide for consistent and sufficiently rapid injection rates for all patients. For protocols in which a peripheral venous injection is called for (e.g. antecubital vein) injection catheters of 18 ga are used where vessel geometry permits. In some patients, particularly women with smaller veins, 20 and 22 ga catheters are used. The effect of catheter size and pressure tubing length can result in high injection pressures that occasionally cause leakage or connector failure. The viscosity of the contrast agent also impacts injection pressure. In this study, a simulation of the injection pathway was constructed with time resolved pressures measured at two points in the pathway. Pressure drops were calculated for a typical MR perfusion injection protocol.     

The Vroman effect in tube geometry: the influence of flow on protein adsorption measurements.

The transient adsorption of fibrinogen from plasma (a manifestation of the Vroman effect), due in large part to displacement by trace proteins such as high-molecular-weight kininogen (HK), factor XII, and plasminogen, has traditionally been studied in nonflowing systems in this laboratory. This paper reports new data on adsorption in tubing geometry under laminar flow. Fibrinogen adsorption from human blood plasma and whole blood diluted to varying exents was measured on glass and polyethylene tubing. The presence of flow did not change the nature of the Vroman effect, except that the processes of adsorption and displacement, which are typically diffusion-limited in static systems, were augmented by convective transport. At the highest applied shear rates of 408 and 510 s-1, the initial adsorption rate of fibrinogen was estimated to be 5.0 X 10(-5) cm/s on both surfaces. The intrinsic rate of displacement of fibrinogen (due to the Vroman effect) at high shear rates was about ten times faster from glass than from polyethylene based on data taken 5 min after the experiment started. The rates of fibrinogen adsorption and displacement were not observed to be significantly augmented by the cellular elements of whole blood at dilutions exceeding 20:1. The consistently observed axial dependence of adsorption in static and flow experiments in tubing geometry was investigated. It was concluded that the effect results, under most conditions, from the creation of a concentration boundary layer during the displacement of the equilibrating buffer by the injected protein solution. The possibility of local depletion due to rapid adsorption during injection or the final displacement of the protein solution was concluded to make lesser contributions to axial variations in measured adsorption.     

Effects of cervical sympathetic stimulation on cerebral and ocular blood flows during hemorrhagic hypotension and moderate hypoxia

The effect of cervical sympathetic stimulation upon regional blood flows was investigated in albino rabbits during graded hemorrhagic hypotension and mild to moderate hypoxic hypoxia. Regional blood flows were determined using labelled microspheres. Cerebral blood flow (CBF) decreased in response to progressive hypotension and increased considerably during hypoxia (100–200%). Unilateral sympathetic stimulation did not change the ipsilateral cerebral flow responses under either condition. There was a greater tendency to autoregulate down to lower blood pressures in deep than in superficial cerebral structures. During hypoxia cortical gray matter blood flow increased relatively more than did white matter blood flow. Blood flow in different parts of the eye decreased during hypotension and tended to increase during hypoxia. Unilateral sympathetic stimulation reduced tlow rates on the stimulated side (10–50% of control side) under both conditions. The vasoconstrictory effect upon retinal blood flow tended. however, to be less during hypoxia. Dural blood flow showed a poor autoregulation and also no consistent vasodilatory response upon hypoxia. Sympathetic stimulation had a very marked effect. The results suggest that the cervical sympathetic nerves do not have any appreciable effect upon cerebral circulation during profound hypotensive and moderate hypoxic states. Dural and most ocular blood flows seem. however. to be clearly affected by sympathetic stimulation even under these extreme conditions.     

Acute effects of acetazolamide on cerbral blood flow in man

We have followed the time course of the effect of the carbonic anhydrase inhibitor acetazolamide injected i. v. in unanesthetized healthy human beings. The dose administered was 500 mg as a bolus. Cerebral blood flow (CBF) was measured continuously before, during and after the injection, using a pulsed ultrasound doppler system, which measured the instantaneous mean velocity across the lumen of the internal carotid artery, just below its entrance into the skull. Ventilation, heart-rate, end-expiratory PCO₂- arterial PCO₂, pH and systemic blood pressure was also measured. We found that acetazolamide caused a rise in CBF which could be detected as early as 2 min after the injection. A maximal average response of 75% increase in CBF was seen after 25 min. The half-time of the declining phase of the response was 95 min. There were no systematic differences in the CO₂ reactivities, given as ACBF/ΔPACO₂ in % of CBF at normocapnia, before and after acetazolamide injection, regardless of the absolute PACO₂ level. The present dose of the drug caused no change in ventilation, alveolar and arterial PCO₂ or in arterial blood pH indicating that the carbonic anhydrase was not fully inhibited. Our observations show that acetazolamide nevertheless caused a rapid vasodilation in the brain and over a wide range of PCO₂′s. We suggest that this agent has a local vasodilator effect on the cerebral arterioles, unrelated to its specific effects as a carbonic anhydrase inhibitor.     

Renal cortical perfusion-Preliminary experience with the Dynamic Spatial Reconstructor (DSR)

The three-dimensional image data generated by the Dynamic Spatial Reconstructor (DSR) enables measurement of the three-dimensional distribution of blood supply in organs. We have applied this imaging technique to evaluate renal cortical blood flow distribution and compare it with distribution of radiolabeled microspheres. The DSR, a high temporal resolution volumetric roentgenographic computed tomographic scanner, was used to scan the volume containing a kidney in 0.13–0.26 s and repeating this scan 8–4 times per s for six s during a renal arteriogram. Five anesthetized dogs were studied in the prone position with the left kidney exteriorized through a flank incision. An electromagnetic flowmeter was placed around the renal artery and a needle placed retrograde into the artery for injection of a 2 cc bolus of contrast agent. During the scan the contrast agent was injected over a four s period during which radioactively labelled microspheres were injected into the left atrium. The tomographic images of approximately 10 parallel, 5 mm thick sagittal slices corresponding to the slices of the kidney used for counting microspheres in the cortical layers were displayed and analyzed. The time point chosen for analysis was the one in which peak brightness (i.e., concentration of contrast agent) was detected in the cortex. The spatial distribution of peak brightness values was compared to the number of microspheres at the same sampling locations. The microsphere-based value of regional cortical blood flow fell below the regression line for the juxtamedullary cortex and above for the outer cortex. This result is consistent with the preferential distribution of microspheres to the outer cortex whereas the contrast agent distributed more uniformly throughout the cortex.     

Responses of the bronchial and pulmonary circulations to short-term nitric oxide inhalation before and after endotoxaemia in the pig

The physiological responses of the bronchial circulation to acute lung injury and endotoxin shock are largely unexplored territory. This study was carried out to study the responsiveness of the bronchial circulation to nitric oxide (NO) inhalation before and after endotoxaemia, in comparison with the pulmonary circulation, as well as to study changes in bronchial blood flow during endotoxaemia. Six anaesthetized pigs (pre-treated with the cortisol-synthesis inhibitor metyrapone) received an infusion of 10 microg/kg endotoxin during 2 h. Absolute bronchial blood flow was measured via an ultrasonic flow probe around the bronchial artery. The pigs received increasing doses of inhaled NO over 5 min each (0, 0.2, 2 and 20 ppm) before and after 4 h of endotoxaemia. The increase in bronchial vascular conductance during 5 min of inhalation of 20 ppm NO before endotoxin shock was significantly higher (area under curve (AUC) 474.2 +/- 84.5% change) than after endotoxin shock (AUC 118.2 +/- 40.4%, P < 0.05 Mann-Whitney U-test). The reduction of the pulmonary arterial pressure by 20 ppm NO was not different. A short rebound effect of the pulmonary arterial pressure occurred after discontinuation of inhaled NO before endotoxaemia (AUC values above baseline 54.4 +/- 19.7% change), and was virtually abolished after endotoxaemia (AUC 6.1 +/- 4.0%, P = 0.052, Mann-Whitney U-test). Our results indicate that the responsiveness of the bronchial circulation to inhalation of increasing doses of inhaled NO during endotoxin shock clearly differ from the responsiveness of the pulmonary circulation. The reduced responsiveness of the bronchial circulation is probably related to decreased driving pressure for the bronchial blood flow. The absence of the short rebound effect on pulmonary arterial pressure (PAP) after induction of shock could be related to maximum constriction of the pulmonary vessels at 4 h.     

Doppler optical coherence imaging of converging flow

The experimental methods of Doppler optical coherence tomography are applied for two-dimensional flow mapping of highly scattering fluid in flow with complex geometry. Converging flow (die entry) is used to demonstrate non-invasive methods to map varying velocity profiles before and after the entry. Complex geometry flow is scanned with approximately 10 x 10 x 10 microm3 spatial resolution. Structural images of the phantom and specific velocity images are demonstrated. A variety of velocity profiles have been obtained before and after the entry. Concave, blunted, parabolic and triangular profiles are obtained at different distances after the entry. Application of the technique to the study of blood circulation is discussed.     

Issues in flow and oxygenation dependent contrast (FLOOD) imaging of tumours.

The sensitivity of blood oxygenation level dependent (BOLD) contrast techniques to changes to tumour deoxyhaemoglobin concentration is of relevance to many strategies in cancer treatments. In the context of tumour studies, which frequently involve the use of agents to modify blood flow, there are underlying physiological changes different to those of BOLD in the brain. Hence we use the term, flow and oxygenation dependent (FLOOD) contrast, to emphasize this difference and the importance of flow effects. We have measured the R(2)* changes in a prolactinoma tumour model for a variety of vasoactive challenges [carbogen, 100% oxygen and 100% nitrogen as different breathing gases, and administration of tumour blood flow modifiers such as calcitonin gene related peptide (CGRP), hydralazine and nicotinamide]. In addition we have measured other relevant physiological parameters, such as bioenergetic status from (31)P MRS, and blood pH and glucose, that may change during a vasoactive challenge. Here we discuss how they relate to our understanding of FLOOD contrast in tumours. We frequently observe R(2)* changes that match the expected action of the vascular stimulus: R(2)* decreases with agents expected to improve tumour oxygenation and blood flow, and increases with agents designed to increase tumour hypoxia. Unlike most normal tissues, tumours have a chaotic and poorly regulated blood supply, and a mix of glycolytic and oxidative metabolism; thus the response to a vasoactive challenge is not predictable. Changes in blood volume can counteract the effect of blood oxygenation changes, and changes in blood pH and glucose levels can alter oxygen extraction. This can lead to R(2)* changes that are smaller or the reverse of those expected. To properly interpret FLOOD contrast changes these effects must be accounted for.     

Effects of sympathetic nerves on cerebral blood flow in awake dogs.

Although cerebral blood vessels are densely innervated by sympathetic nerve fibers, the functional significance of the nerves is controversial. Because previous studies have been primarily performed in anesthetized animals, it is possible that failure to observe prominent neural control of the cerebral circulation was secondary to anesthetic-induced depression of the sympathetic nervous system. Therefore, we studied sympathetic control of the cerebral circulation in 11 awake chronically instrumented dogs. Total and regional cerebral blood flow was measured with 15-micrometer microspheres at control blood pressure and during three levels of progressive hemorrhagic hypotension. Sympathetic nerves had only a small effect (11% decrease; P less than 0.05) on flow to the cerebrum during moderate hypotension (mean arterial pressure 49 +/- 2 mmHg). Also, during severe hypotension, there was a bilateral redistribution of brain blood flow that tended to preserve flow to the medulla. Although these studies suggest that sympathetic nerves have a definite constrictor effect on cerebral vessels, the data support the concept that the functional importance of sympathetic nerves to cerebral vessels is limited.     

Dynamic contrast enhanced CT measurement of blood flow during interstitial laser photocoagulation: comparison with an Arrhenius damage model

One effect of heating during interstitial laser photocoagulation (ILP) is to directly destroy the tumour vasculature resulting in a loss of viable blood supply. Therefore, blood flow measured during and after treatment can be a useful indicator of tissue thermal damage. In this study, the effect of ILP treatment on rabbit thigh tumours was investigated by measuring blood flow changes using dynamic contrast enhanced computed tomography (CT). The CT measured changes in blood flow of treated tumour tissue were fitted to an Arrhenius model assuming first order rate kinetics. Our results show that changes in blood flow of tumour tissue distant from surrounding normal tissue are well described by an Arrhenius model. By contrast, the temperature profile of tumour tissue adjacent to normal tissue must be modified to account for heat dissipation by the latter. Finally, the Arrhenius parameters derived in the study are similar to those derived by heating tumour tissue to a lower temperature (<47 degrees C) than the current study. In conclusion, CT can be used to monitor blood flow changes during ILP and these measurements are related to the thermal damage predicted by the Arrhenius model.     

Effects of time-varying flow and volume on cardiac output estimation from isotope dilution and residue detection

Measurements of cardiac output from indicator dilution are subject to error when tracer is sampled at a constant rate but flow varies periodically. Using a pulsatile compartmental representation of a segment of the central circulation, we have examined the effect of time-varying flow and volume on determinations of cardiac output from isotope dilution and region-of-interest residue detection. The effects of input function dispersion, amplitude of flow variation, relative duration of systole, and injection directly into and proximal to a region-of-interest were studied. In contrast to distal concentration sampling where errors for comparable injection and flow characteristics are minimal at cardiac frequencies, errors from residue detection procedures can be as high as 15 to 20%, and depend on the region-of-interest, injection timing, and system parameters. Errors decrease with peripheral injection, increased dispersion of the input function, increased fractional duration of systole, and reduced amplitude of flow variation. Specific procedures for minimizing errors due to time-varying flow are discussed.     

Absorbed dose in the presence of contrast agents during pediatric cardiac catheterization

Administration of x-ray contrast agents during heart catheterization examination increases the absorbed radiation dose in tissue. To estimate the dose absorbed by the blood of children undergoing diagnostic heart catheterization and angiocardiography, a number of measurements and calculations were conducted. First, entrance and exit exposures to the patient were measured with thermoluminescent dosimeters calibrated for the diagnostic x-ray energy range. Second, a dose enhancement factor was calculated from mass energy absorption coefficients for various concentrations of the contrast media and at selected x-ray energies. Third, the dose enhancement factor was estimated from survival of peripheral blood lymphocytes suspended in varying concentrations of the contrast agent during exposure to graded doses of x-rays. Fourth, a mean absorbed dose to the patient's blood was calculated using (a) the dose enhancement factor determined above, (b) an estimate of the mean exposure in the irradiated body volume calculated from the entrance and exit exposure measurements, (c) an effective iodine concentration in the blood during the exposure time, and (d) a ratio correcting for the distribution and circulation of the blood. For eight pediatric patients monitored, absorbed doses to the blood ranged between 3 and 12 rad. These values were two to three times greater than the expected dose without administration of a contrast agent.     

Timing and reproducibility of access flow measurements using extracorporeal temperature gradients

The duration, accuracy, and reproducibility of a new access flow measuring technique was analyzed in a series of in vitro experiments using an extracorporeal line switch that allowed for almost instantaneous reversal of extracorporeal blood flow without disconnecting the blood lines. Access flow was modeled from the magnitude and time course of extracorporeal temperature changes caused by switching the blood lines. Ten tests were done with access flows covering a range from 410 to 1500 ml min. The coefficient of variation of triplicate access flow identifications was 3.8 +/- 1.5%. The mean bias between measured and modeled access flows was 54 +/- 54 ml min and independent of the range of measured access flows. The average time constant for temperatures to stabilize after switching the blood lines was 0.68 +/- 0.11 min. These results show that the instantaneous change in the direction of blood flow in proximal parts of the extracorporeal circulation produces a smooth change in extracorporeal temperatures that can be explained by a mathematical model incorporating access flow and that a reproducible measure for access blood flow can be obtained as one of the model parameters from that fit within a few minutes of switching the blood lines without the injection of indicator.     

Imaging of non-parabolic velocity profiles in converging flow with optical coherence tomography

The optical coherence tomography method was explored for two-dimensional flow mapping of a highly scattering fluid in flow with complex geometry. Converging flow (capillary entry) with 4:1 constriction was used for demonstration of non-invasive and remote methods of mapping varying velocity profiles. Downstream of the geometry was scanned with approximately 10 x 10 x 10 microm3 spatial resolution and structural imaging of the lumen and images of one particular velocity were acquired. Stable concave, blunted and parabolic profiles are obtained at different distances of the inlet length. Application of the technique for the blood circulation is also discussed.     

Influence of central command and ergoreceptors on the splanchnic circulation during isometric exercise

The splanchnic circulation can make a major contribution to blood flow changes. However, the role of the splanchnic circulation in the reflex adjustments to the blood pressure increase during isometric exercise is not well documented. The central command and the muscle chemoreflex are the two major mechanisms involved in the blood pressure response to isometric exercise. This study aimed to examine the behaviour of the superior mesenteric artery during isometric handgrip (IHG) at 30% maximal voluntary contraction (MVC). The pulsatility index (PI) of the blood velocity waveform of the superior mesenteric artery was taken as the study parameter. A total of ten healthy subjects [mean age, 21.1 (SEM 0.3) years] performed an IHG at 30% MVC for 90 s. At 5 s prior to the end of the exercise, muscle circulation was arrested for 90 s to study the effect of the muscle chemoreflex (post exercise arterial occlusion, PEAO). The IHG at 30% MVC caused a decrease in superior mesenteric artery PI, from 4.84 (SEM 1.57) at control level to 3.90 (SEM 1.07) (P = 0.015). The PI further decreased to 3.17 (SEM 0.70) (P = 0.01) during PEAO. Our results indicated that ergoreceptors may be involved in the superior mesenteric artery vasodilatation during isometric exercise.     

Effect of local cold provocation on systolic blood pressure and skin blood flow in the finger.

Demonstration of increased vascular cold reactivity in patients with Raynaud's syndrome is difficult. For medico-legal reasons, it is important to get objective measures of vasospasm in these patients. Evaluation of the degree of vasospasm also provides prognostic information which is useful for patient management. In this study, we compare two methods of arterial circulation measurement. The laser Doppler scanning is a new method, which uses the recently developed laser Doppler perfusion imaging (LDPI) instrument. The aim of the present study was to compare the effect on finger skin blood flow measured with LDPI with changes in finger systolic blood pressure during local cold provocation. The effect of such provocation, skin blood flow and systolic blood pressure, were studied in 15 healthy controls. Six patients with known traumatic vasospastic disease (TVD) were also tested with both methods. Finger skin blood flow was measured with LDPI on the distal phalanx of the index finger of the left hand, every minutes during 6 min of local heating at 40 degrees C followed by local cooling for 3 min at 15 degrees C and then for 3 min at 10 degrees C. Finger systolic blood pressure was measured with strain-gauge method before and after local cooling to 10 degrees C with a cuff perfused with water of desired temperature. The test was performed in the same finger within a week of the laser Doppler scanning. Local finger cooling to 15 degrees C and 10 degrees C caused a significant decrease in blood flow, most marked at 10 degrees C. There was, however, no correlation between the decrease in blood flow and blood pressure. In the TVD-patients decreases in skin blood flow were similar compared with the healthy controls. In contrast, the changes in systolic blood pressure, were outside normal range (systolic quotient <0.65) in five of the six patients (83%), and also in 11 of the 15 healthy controls (73%). In conclusion, there is no correlation between the decrease in finger skin blood flow and systolic blood pressure during local cold provocation. For diagnosis of traumatic vasospastic disease (TVD), local cold-induced changes in finger systolic blood pressure seems superior to changes in skin blood flow, but the ideal clinical method for demonstrating increased cold-induced vasospasm is, however, still lacking.