An Overview

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Perfusion imaging gives access to information on the capillary microcirculation of tissue. The main quantitative parameters measured are blood flow, blood volume, and temporal data (mean transit time, time to peak, time to peak of the residue funcion [Tmax]).

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The ultimate goal of perfusion MRI is to measure or assess the blood flow irrigating the explored organ, expressed in milliliters per 100 gram of tissue per minute. This flow corresponds to microcirculatory tissue perfusion rather than the flow of the main vascular axes.

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The most common methods for measuring perfusion include perfusion CT, dynamic susceptibility contrast (DSC), dynamic contrast enhancement (DCE), and arterial spin labeling (ASL), which uses magnetically labeled arterial blood water as a diffusible flow tracer. ASL also has utlity for detecting arterio-venous shunt lesions, such as arteriovenous malformations (AVM’s) and dural arteriovenous fistulas (dAVF), that may be difficult to characterize with anatomic imaging. Practical utility of perfusion imaging has been demonstrated for several neuroimaging applications, including acute and chronic cerebrovascular disease, CNS neoplasms, epilepsy, etc.

 

Perfusion Imaging Publication References

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Provenzale JM, Wintermark M. “Optimization of perfusion imaging for acute cerebral ischemia: review of recent clinical trials and recommendations for future studies”: AJR. American Journal of Roentgenology. Oct 2008;191(4):1263-70.

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Leiva-Salinas C, Provenzale JM, Kudo K, Sasaki M, Wintermark M. The alphabet soup of perfusion CT and MR imaging: terminology revisited and clarified in five  questions. Neuroradiology. 2012 Sep;54(9):907-18. doi: 10.1007/s00234-012-1028-6. Epub 2012 Apr 10. Review. PubMed PMID: 22488209.

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Leiva-Salinas C, Provenzale JM, Wintermark M. Responses to the 10 most frequently asked questions about perfusion CT. AJR Am J Roentgenol. 2011 Jan;196(1):53-60. doi: 10.2214/AJR.10.5705. Review. PubMed PMID: 21178046.

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Essig M, Shiroishi MS, Nguyen TB, Saake M, Provenzale JM, Enterline D, Anzalone N, Dörfler A, Rovira A, Wintermark M, Law M. Perfusion MRI: the five most frequently asked technical questions. AJR Am J Roentgenol. 2013 Jan;200(1):24-34. doi: 10.2214/AJR.12.9543. Review. PubMed PMID: 23255738; PubMed Central PMCID: PMC3593114.

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Essig M, Nguyen TB, Shiroishi MS, Saake M, Provenzale JM, Enterline DS, Anzalone N, Dörfler A, Rovira À, Wintermark M, Law M. Perfusion MRI: the five most frequently asked clinical questions. AJR Am J Roentgenol. 2013 Sep;201(3):W495-510. doi: 10.2214/AJR.12.9544. Review. PubMed PMID: 23971482; PubMed Central PMCID: PMC3842445.

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Shiroishi MS, Castellazzi G, Boxerman JL, D'Amore F, Essig M, Nguyen TB, Provenzale JM, Enterline DS, Anzalone N, Dörfler A, Rovira À, Wintermark M, Law M. Principles of T2 *-weighted dynamic susceptibility contrast MRI technique in brain tumor imaging. J Magn Reson Imaging. 2015 Feb;41(2):296-313. doi: 10.1002/jmri.24648. Epub 2014 May 12. Review. PubMed PMID: 24817252.

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Welker K, Boxerman J, Kalnin A, Kaufmann T, Shiroishi M, Wintermark M; American Society of Functional Neuroradiology MR Perfusion Standards and Practice Subcommittee of the ASFNR Clinical Practice Committee. ASFNR recommendations for  clinical performance of MR dynamic susceptibility contrast perfusion imaging of the brain. AJNR Am J Neuroradiol. 2015 Jun;36(6):E41-51. doi: 10.3174/ajnr.A4341. Epub 2015 Apr 23. PubMed PMID: 25907520; PubMed Central PMCID: PMC5074767.

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Alsop DC, Detre JA, Golay X, Günther M, Hendrikse J, Hernandez-Garcia L, Lu H, MacIntosh BJ, Parkes LM, Smits M, van Osch MJ, Wang DJ, Wong EC, Zaharchuk G.

Recommended implementation of arterial spin-labeled perfusion MRI for clinical applications: A consensus of the ISMRM perfusion study group and the European consortium for ASL in dementia. Magn Reson Med. 2015 Jan;73(1):102-16. doi: 10.1002/mrm.25197. Epub 2014 Apr 8. Review. PubMed PMID: 24715426; PubMed Central PMCID: PMC4190138.

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Deibler AR, Pollock JM, Kraft RA, Tan H, Burdette JH, Maldjian JA. “Arterial Spin-labeling in routine clinical practice, part 1:technique and artifacts”. AJNR America Journal Neuroradiology. Aug 2008;29(7): 1228-34.

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Deibler AR, Pollock JM, Kraft RA, Tan H, Burdette JH, Maldjian JA. “Arterial spin labeling in routine clinical practice, part 2: hypoperfusion patterns”. AJNR American Journal Neuroradiology. Aug 2008;29(7): 1235-41.

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Deibler AR, Pollock JM, Kraft RA, Tan H, Burdette JH, Maldjian JA. “Arterial spin labeling in routine clinical practice, part 3: hyperperfusion patterns”. AJNR American Journal Neuroradiology. Sept 2008;29(8): 1428-35.

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Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT; American College of Radiology Head Injury Institute. Imaging evidence and recommendations for traumatic brain injury: advanced neuro- and neurovascular imaging techniques. AJNR Am J Neuroradiol. 2015 Feb;36(2):E1-E11. doi: 10.3174/ajnr.A4181. Epub 2014  Nov 25. PubMed PMID: 25424870.

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Wintermark M, Sanelli PC, Albers GW, Bello JA, Derdeyn CP, Hetts SW, Johnson MH, Kidwell CS, Lev MH, Liebeskind DS, Rowley HA, Schaefer PW, Sunshine JL, Zaharchuk G, Meltzer CC; American Society of Neuroradiology; American College of  Radiology; Society of NeuroInterventional Surgery. Imaging recommendations for acute stroke and transient ischemic attack patients: a joint statement by the American Society of Neuroradiology, the American College of Radiology and the Society of NeuroInterventional Surgery. J Am Coll Radiol. 2013 Nov;10(11):828-32. doi: 10.1016/j.jacr.2013.06.019. Epub 2013 Aug 13. PubMed PMID: 23948676; PubMed  Central PMCID: PMC4142765.

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Gharzeddine K, Hatzoglou V, Holodny AI, Young RJ. MR Perfusion and MR Spectroscopy of Brain Neoplasms. Radiol Clin North Am. 2019 Nov;57(6):1177-1188.  doi: 10.1016/j.rcl.2019.07.008. Review. PubMed PMID: 31582043.