(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.

The mobile intraoperative iMotion system produces real-time images used for MR guided surgery and offers functional magnetic resonance imaging, MR spectroscopy, perfusion imaging, and diffusion weighted imaging capabilities.
The iMotion 1.5 T magnet moves to the patient, gliding in and out of place as needed, without affecting surgical, anesthetic, and nursing management.

See also Intraoperative Magnetic Resonance Imaging, MR Guided Interventions.

(ASL) A MR image can be sensitized to the effect of inflowing blood spins if those spins are in a different magnetic state to that of the static tissue. Techniques known as ASL techniques uses this idea by magnetically labeling blood flowing into the slices of interest. Contrast agents are not required for these techniques. This perfusion measurement is completely noninvasive.
Blood flowing into the imaging slice exchanges with tissue water, altering the tissue magnetization. A perfusion-weighted image can be generated by the subtraction of an image in which inflowing spins have been labeled from an image in which spin labeling has not been performed. Quantitative perfusion maps can be calculated if other parameters (such as tissue T1 and the efficiency of spin labeling) also are measured.

(DWI) Magnetic resonance imaging is sensitive to diffusion, because the diffusion of water molecules along a field gradient reduces the MR signal. In areas of lower diffusion the signal loss is less intense and the display from this areas is brighter. The use of a bipolar gradient pulse and suitable pulse sequences permits the acquisition of diffusion weighted images (images in which areas of rapid proton diffusion can be distinguished from areas with slow diffusion).
Based on echo planar imaging, multislice DWI is today a standard for imaging brain infarction. With enhanced gradients, the whole brain can be scanned within seconds. The degree of diffusion weighting correlates with the strength of the diffusion gradients, characterized by the b-value, which is a function of the gradient related parameters: strength, duration, and the period between diffusion gradients.
Certain illnesses show restrictions of diffusion, for example demyelinization and cytotoxic edema. Areas of cerebral infarction have decreased apparent diffusion, which results in increased signal intensity on diffusion weighted MRI scans. DWI has been demonstrated to be more sensitive for the early detection of stroke than standard pulse sequences and is closely related to temperature mapping.
DWIBS is a new diffusion weighted imaging technique for the whole body that produces PET-like images. The DWIBS sequence has been developed with the aim to detect lymph nodes and to differentiate normal and hyperplastic from metastatic lymph nodes. This may be possible caused by alterations in microcirculation and water diffusivity within cancer metastases in lymph nodes.

See also Diffusion Weighted Sequence, Perfusion Imaging, ADC Map, Apparent Diffusion Coefficient, and Diffusion Tensor Imaging.

(PRESTO) PRESTO is a 3 dimensional ultrafast gradient echo sequence that combines the whole brain coverage with T2* weighted imaging. PRESTO is useful for BOLD and perfusion imaging studies. In combination with parallel imaging techniques, PRESTO provides higher temporal resolution and more coverage compared to traditional multi slice imaging. In addition, the sensitivity to susceptibility artifacts and flow phenomena is reduced, compared with EPI techniques, enabling MRI scans throughout the brain including the skull base.

See also T2 Star.