(PWI - Perfusion
Weighted Imaging) Perfusion
MRI techniques (e.g. PRESTO -
Principles of Echo Shifting using a Train of Observations) are sensitive to microscopic levels of blood
flow.
Contrast enhanced relative cerebral blood volume (rCBV) is the most used perfusion
imaging.
Both, the ready availability and the
T2* susceptibility effects of
gadolinium, rather than the
T1 shortening effects make
gadolinium a suitable agent for use in perfusion
imaging.
Susceptibility here refers to the loss of MR signal, most marked on
T2* (
gradient echo)-
weighted and
T2 (
spin echo)-
weighted sequences, caused by the magnetic field-distorting effects of paramagnetic substances.
T2* perfusion uses dynamic
sequences based on multi or single
shot techniques. The
T2* (
T2)
MRI signal drop within or across a
brain region is caused by
spin dephasing during the rapid passage of
contrast agent through the capillary bed. The signal decrease is used to compute the relative perfusion to that region. The
bolus through the tissue is only a few seconds, high
temporal resolution imaging is required to obtain sequential images during the wash in and wash out of the
contrast material and therefore, resolve the first pass of the tracer. Due to the high
temporal resolution, processing and calculation of hemodynamic maps are available (including mean transit time (MTT),
time to peak (TTP), time of arrival (T0), negative
integral (N1) and index.
An important neuroradiological indication for
MRI is the evaluation of incipient or acute stroke via perfusion and
diffusion imaging.
Diffusion imaging can demonstrate the central effect of a stroke on the
brain, whereas perfusion
imaging visualizes the larger 'second ring' delineating blood
flow and blood volume. Qualitative and in some instances quantitative (e.g. quantitative
imaging of perfusion using a single subtraction) maps of regional organ perfusion can thus be obtained.
Echo planar and potentially
echo volume techniques together with appropriate computing power offer
real time images of dynamic variations in water characteristics reflecting perfusion,
diffusion, oxygenation (see also
Oxygen Mapping) and
flow.
Another type of perfusion
MR imaging allows the evaluation of myocardial ischemia during pharmacologic stress. After e.g., adenosine infusion, multiple short axis views (see
cardiac axes) of the heart are obtained during the administration of
gadolinium contrast. Ischemic areas show up as areas of delayed and diminished enhancement. The
MRI stress perfusion has been shown to be more accurate than nuclear SPECT exams.
Myocardial late enhancement and stress perfusion
imaging can also be performed during the same
cardiac MRI examination.