| Perfusion MRI | |
|---|---|
 MRI perfusion showing a delayed time-to-maximum flow (Tmax) in the penumbra in a case of occlusion of the left middle cerebral artery. | |
| Purpose | perfusion scanning via MRI |
Perfusion MRI or perfusion-weighted imaging (PWI) is perfusion scanning by the use of a particular MRI sequence [ which? ]. The acquired data are then post-processed to obtain perfusion maps with different parameters, such as BV (blood volume), BF (blood flow), MTT (mean transit time) and TTP (time to peak).
In cerebral infarction, the penumbra has decreased perfusion. [1] Another MRI sequence, diffusion weighted MRI, estimates the amount of tissue that is already necrotic, and the combination of those sequences can therefore be used to estimate the amount of brain tissue that is salvageable by thrombolysis and/or thrombectomy. [1]
There are 3 main techniques for perfusion MRI:
It can also be argued that diffusion MRI models, such as intravoxel incoherent motion, also attempt to capture perfusion.
In Dynamic susceptibility contrast MR imaging (DSC-MRI, or simply DSC), Gadolinium contrast agent (Gd) is injected (usually intravenously) and a time series of fast T2*-weighted images is acquired. As Gadolinium passes through the tissues, it induces a reduction of T2* in the nearby water protons; the corresponding decrease in signal intensity observed depends on the local Gd concentration, which may be considered a proxy for perfusion. The acquired time series data are then postprocessed to obtain perfusion maps with different parameters, such as BV (blood volume), BF (blood flow), MTT (mean transit time) and TTP (time to peak).
Dynamic contrast-enhanced (DCE) imaging gives information about physiological tissue characteristics such transport from blood to tissue and blood volume. It is typically used to measure how a contrast agent moves from the blood to the tissue. The concentration of the contrast agent is measured as it passes from the blood vessels to the extracellular space of the tissue (it does not pass the membranes of cells) and as it goes back to the blood vessels. [5] [6]
The contrast agents used for DCE-MRI are often gadolinium based. Interaction with the gadolinium (Gd) contrast agent (commonly a gadolinium ion chelate) causes the relaxation time of water protons to decrease, and therefore images acquired after gadolinium injection display higher signal in T1-weighted images indicating the present of the agent. It is important to note that, unlike some techniques such as PET imaging, the contrast agent is not imaged directly, but by an indirect effect on water protons. The common procedure for a DCE-MRI exam is to acquire a regular T1-weighted MRI scan (with no gadolinium), and then gadolinium is injected (usually as an intravenous bolus at a dose of 0.05–0.1 mmol/kg) before further T1-weighted scanning. DCE-MRI may be acquired with or without a pause for contrast injection and may have varying time resolution depending on preference – faster imaging (less than 10s per imaging volume) allows pharmacokinetic (PK) modelling of contrast agent but can limit possible image resolution. Slower time resolution allows more detailed images, but may limit interpretation to only looking at signal intensity curve shape. In general, persistent increased signal intensity (corresponding to decreased T1 and thus increased Gd interaction) in a DCE-MRI image voxel indicates permeable blood vessels characteristic of tumor tissue, where Gd has leaked into the extravascular extracellular space. In tissues with healthy cells or a high cell density, gadolinium re-enters the vessels faster since it cannot pass the cell membranes. In damaged tissues or tissues with a lower cell density, the gadolinium stays in the extracellular space longer.
Pharmacokinetic modelling of gadolinium in DCE-MRI is complex and requires choosing a model. There are a variety of models, which describe tissue structure differently, including size and structure of plasma fraction, extravascular extracellular space, and the resulting parameters relating to permeability, surface area, and transfer constants. [7] DCE-MRI can also provide model-independent parameters, such as T1 (which is not technically part of the contrast scan and can be acquired independently) and (initial) area under the gadolinium curve (IAUGC, often given with number of seconds from injection - i.e., IAUGC60), which may be more reproducible. [8] Accurate measurement of T1 is required for some pharmacokinetic models, which can be estimated from 2 pre-gadolinium images of varying excitation pulse flip angle, [9] though this method is not intrinsically quantitative. [10] Some models require knowledge of the arterial input function, which may be measured on a per patient basis or taken as a population function from literature, and can be an important variable for modelling. [11]
Arterial spin labelling (ASL) has the advantage of not relying on an injected contrast agent, instead inferring perfusion from a drop in signal observed in the imaging slice arising from inflowing spins (outside the imaging slice) having been selectively inverted or saturated. A number of ASL schemes are possible, the simplest being flow alternating inversion recovery (FAIR) which requires two acquisitions of identical parameters with the exception of the out-of-slice inversion; the difference in the two images is theoretically only from inflowing spins, and may be considered a 'perfusion map'.
Gadolinium is a chemical element; it has symbol Gd and atomic number 64. Gadolinium is a silvery-white metal when oxidation is removed. It is a malleable and ductile rare-earth element. Gadolinium reacts with atmospheric oxygen or moisture slowly to form a black coating. Gadolinium below its Curie point of 20 °C (68 °F) is ferromagnetic, with an attraction to a magnetic field higher than that of nickel. Above this temperature it is the most paramagnetic element. It is found in nature only in an oxidized form. When separated, it usually has impurities of the other rare-earths because of their similar chemical properties.
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves to generate images of the organs in the body. MRI does not involve X-rays or the use of ionizing radiation, which distinguishes it from computed tomography (CT) and positron emission tomography (PET) scans. MRI is a medical application of nuclear magnetic resonance (NMR) which can also be used for imaging in other NMR applications, such as NMR spectroscopy.
Perfusion is the passage of fluid through the circulatory system or lymphatic system to an organ or a tissue, usually referring to the delivery of blood to a capillary bed in tissue. Perfusion may also refer to fixation via perfusion, used in histological studies. Perfusion is measured as the rate at which blood is delivered to tissue, or volume of blood per unit time per unit tissue mass. The SI unit is m3/(s·kg), although for human organs perfusion is typically reported in ml/min/g. The word is derived from the French verb "perfuser" meaning to "pour over or through". All animal tissues require an adequate blood supply for health and life. Poor perfusion (malperfusion), that is, ischemia, causes health problems, as seen in cardiovascular disease, including coronary artery disease, cerebrovascular disease, peripheral artery disease, and many other conditions.
Magnetic resonance angiography (MRA) is a group of techniques based on magnetic resonance imaging (MRI) to image blood vessels. Magnetic resonance angiography is used to generate images of arteries in order to evaluate them for stenosis, occlusions, aneurysms or other abnormalities. MRA is often used to evaluate the arteries of the neck and brain, the thoracic and abdominal aorta, the renal arteries, and the legs.
Gadopentetic acid, sold under the brand name Magnevist, is a gadolinium-based MRI contrast agent.
Kenneth Kin Man Kwong is a Hong Kong-born American nuclear physicist. He is a pioneer in human brain imaging. He received his bachelor's degree in Political Science in 1972 from the University of California, Berkeley. He went on to receive his Ph.D. in physics from the University of California, Riverside studying photon-photon collision interactions.
MRI contrast agents are contrast agents used to improve the visibility of internal body structures in magnetic resonance imaging (MRI). The most commonly used compounds for contrast enhancement are gadolinium-based contrast agents (GBCAs). Such MRI contrast agents shorten the relaxation times of nuclei within body tissues following oral or intravenous administration.
Cardiac magnetic resonance imaging, also known as cardiovascular MRI, is a magnetic resonance imaging (MRI) technology used for non-invasive assessment of the function and structure of the cardiovascular system. Conditions in which it is performed include congenital heart disease, cardiomyopathies and valvular heart disease, diseases of the aorta such as dissection, aneurysm and coarctation, coronary heart disease. It can also be used to look at pulmonary veins. Patient information may be found here.
Perfusion is the passage of fluid through the lymphatic system or blood vessels to an organ or a tissue. The practice of perfusion scanning is the process by which this perfusion can be observed, recorded and quantified. The term perfusion scanning encompasses a wide range of medical imaging modalities.
Susceptibility weighted imaging (SWI), originally called BOLD venographic imaging, is an MRI sequence that is exquisitely sensitive to venous blood, hemorrhage and iron storage. SWI uses a fully flow compensated, long echo, gradient recalled echo (GRE) pulse sequence to acquire images. This method exploits the susceptibility differences between tissues and uses the phase image to detect these differences. The magnitude and phase data are combined to produce an enhanced contrast magnitude image. The imaging of venous blood with SWI is a blood-oxygen-level dependent (BOLD) technique which is why it was referred to as BOLD venography. Due to its sensitivity to venous blood SWI is commonly used in traumatic brain injuries (TBI) and for high resolution brain venographies but has many other clinical applications. SWI is offered as a clinical package by Philips and Siemens but can be run on any manufacturer's machine at field strengths of 1.0 T, 1.5 T, 3.0 T and higher.
The physics of magnetic resonance imaging (MRI) concerns fundamental physical considerations of MRI techniques and technological aspects of MRI devices. MRI is a medical imaging technique mostly used in radiology and nuclear medicine in order to investigate the anatomy and physiology of the body, and to detect pathologies including tumors, inflammation, neurological conditions such as stroke, disorders of muscles and joints, and abnormalities in the heart and blood vessels among others. Contrast agents may be injected intravenously or into a joint to enhance the image and facilitate diagnosis. Unlike CT and X-ray, MRI uses no ionizing radiation and is, therefore, a safe procedure suitable for diagnosis in children and repeated runs. Patients with specific non-ferromagnetic metal implants, cochlear implants, and cardiac pacemakers nowadays may also have an MRI in spite of effects of the strong magnetic fields. This does not apply on older devices, and details for medical professionals are provided by the device's manufacturer.
Quantitative susceptibility mapping (QSM) provides a novel contrast mechanism in magnetic resonance imaging (MRI) different from traditional susceptibility weighted imaging. The voxel intensity in QSM is linearly proportional to the underlying tissue apparent magnetic susceptibility, which is useful for chemical identification and quantification of specific biomarkers including iron, calcium, gadolinium, and super paramagnetic iron oxide (SPIO) nano-particles. QSM utilizes phase images, solves the magnetic field to susceptibility source inverse problem, and generates a three-dimensional susceptibility distribution. Due to its quantitative nature and sensitivity to certain kinds of material, potential QSM applications include standardized quantitative stratification of cerebral microbleeds and neurodegenerative disease, accurate gadolinium quantification in contrast enhanced MRI, and direct monitoring of targeted theranostic drug biodistribution in nanomedicine.
Magnetic resonance imaging of the brain uses magnetic resonance imaging (MRI) to produce high quality two-dimensional or three-dimensional images of the brain and brainstem as well as the cerebellum without the use of ionizing radiation (X-rays) or radioactive tracers.
Intravoxel incoherent motion (IVIM) imaging is a concept and a method initially introduced and developed by Le Bihan et al. to quantitatively assess all the microscopic translational motions that could contribute to the signal acquired with diffusion MRI. In this model, biological tissue contains two distinct environments: molecular diffusion of water in the tissue, and microcirculation of blood in the capillary network (perfusion). The concept introduced by D. Le Bihan is that water flowing in capillaries mimics a random walk (Fig.1), as long as the assumption that all directions are represented in the capillaries is satisfied.
Blood pool agents (BPAs) are a class of magnetic resonance angiography contrast agents. Blood pool agents are differentiated from other contrast agents due to their high molecular weight and higher relaxivities. Their large size prevents diffusion through the vascular epithelium and leakage into the interstitial space, and because of this they stay in the vascular system for a longer time period. Most contrast agents, leave the vascular system within a few minutes, however blood pool agents remain in the circulation for up to an hour, extending the window available for imaging. Longer image acquisition times allow better signal-to-noise ratio and improved image resolution.
An MRI pulse sequence in magnetic resonance imaging (MRI) is a particular setting of pulse sequences and pulsed field gradients, resulting in a particular image appearance.
Gradient echo is a magnetic resonance imaging (MRI) sequence that has wide variety of applications, from magnetic resonance angiography to perfusion MRI and diffusion MRI. Rapid imaging acquisition allows it to be applied to 2D and 3D MRI imaging. Gradient echo uses magnetic gradients to generate a signal, instead of using 180 degrees radiofrequency pulse like spin echo; thus leading to faster image acquisition time.
Arterial spin labeling (ASL), also known as arterial spin tagging, is a magnetic resonance imaging technique used to quantify cerebral blood perfusion by labelling blood water as it flows throughout the brain. ASL specifically refers to magnetic labeling of arterial blood below or in the imaging slab, without the need of gadolinium contrast. A number of ASL schemes are possible, the simplest being flow alternating inversion recovery (FAIR) which requires two acquisitions of identical parameters with the exception of the out-of-slice saturation; the difference in the two images is theoretically only from inflowing spins, and may be considered a 'perfusion map'. The ASL technique was developed by Alan P. Koretsky, Donald S. Williams, John A. Detre and John S. Leigh Jr in 1992.
Inversion recovery is an MRI sequence that provides high contrast between tissue and lesion. It can be used to provide high T1 weighted image, high T2 weighted image, and to suppress the signals from fat, blood, or cerebrospinal fluid (CSF).
Magnetic resonance fingerprinting (MRF) is methodology in quantitative magnetic resonance imaging (MRI) characterized by a pseudo-randomized acquisition strategy. It involves creating unique signal patterns or 'fingerprints' for different materials or tissues after which a pattern recognition algorithm matches these fingerprints with a predefined dictionary of expected signal patterns. This process translates the data into quantitative maps, revealing information about the magnetic properties being investigated.
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