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Neuroimaging Techniques in Clinical Practice pp 141–164Cite as

MRI Perfusion Techniques

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Abstract

MRI-based perfusion techniques have become an integral part of neuroimaging and several different MRI techniques are now available for analysis of tissue perfusion and related hemodynamic parameters. This chapter gives an overview of the three MRI-based perfusion imaging techniques; dynamic susceptibility contrast (DSC)-MRI, dynamic contrast-enhanced (DCE)-MRI and arterial spin labeling (ASL). An introduction to the physical principles of the three methods will be given, as well as the different kinetic models that are applied in the analysis. This is followed by an overview of current clinical applications of the three techniques in the main indication areas: CNS cancers, cerebrovascular disease, neurodegenerative disease, and demyelinating disease. Finally, some thoughts about the future direction of perfusion-based MRI techniques and their clinical impact will be given.

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Notes

  1. 1.

    ‘Tracer’ will be used here as the general term for any agent used to induce a temporal MRI signal change in tissue.

  2. 2.

    The term ‘T2∗-relaxation’ here refers to the effective transverse relaxation rate in a gradient echo sequence where static inhomogeneities are not refocussed; in contrast to T2-relaxation where static dephasing is eliminated by use of refocusing RF-pulses. For simplicity, the term ‘T2-relaxation’ will be used to describe both effects, unless the difference between the two effects is explicitly addressed.

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Authors and Affiliations

  1. Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway

    Kyrre E. Emblem

  2. Department of Neurosurgery, Oslo University Hospital, Oslo, Norway

    Christopher Larsson

  3. Computational Radiology and Artificial Intelligence (CRAI) Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

    Inge R. Groote

  4. Computational Radiology and Artificial Intelligence (CRAI) Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

    Atle Bjørnerud

  5. Department of Physics, University of Oslo, Oslo, Norway

    Atle Bjørnerud

Authors
  1. Kyrre E. Emblem
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  2. Christopher Larsson
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  3. Inge R. Groote
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  4. Atle Bjørnerud
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Correspondence to Atle Bjørnerud .

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Editors and Affiliations

  1. University Clinic for Radiology, University Hospital of Münster, Münster, Germany

    Manoj Mannil

  2. Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland

    Sebastian F.-X. Winklhofer

Clinical Case

Clinical Case

figure a

Images obtained in a 58-year-old male included in a prospective study of MRI imaging markers during standard radiochemotherapy (RCT) treatment in patients with high-grade gliomas. Relative cerebral volume (rCBV) maps from DSC-MRI and volume transfer constant (Ktrans) maps from DCE-MRI were generated. The images to the left were taken the day before the RCT start. The T1w post-contrast series show some contrast enhancement with surrounding edema. Ktrans in the contrast-enhancing area shows homogenous leakage in tumor rim. rCBV in tumor is similar to that of gray matter. Images taken 2 weeks after radiation therapy (RT) end (8 weeks after pretreatment scans) show an increase in the contrast-enhancing area. The Ktrans values in tumor are mostly unchanged from baseline but a small area of increased leakage is noted toward the midline. rCBV is not elevated. At 6 months post-RT, a small contrast-enhancing nodule is still present. Ktrans in the nodule is unchanged and there is still no increased rCBV. At the 1-year control after start of RCT, a large increase in contrast enhancement is seen. There are increased edema and a midline shift. The patient reported slight fatigue but no clear clinical deterioration. Interestingly, the Ktrans values are still not increased compared to the values from the first examination. Similarly, no increase in rCBV is seen. However, due to the increase in contrast enhancement, midline shift, and late onset of these changes, a new surgery was scheduled. The biopsy from the surgery showed changes from radiation necrosis. No signs of tumor recurrence were seen. This shows the possible utility of perfusion imaging for differentiation of treatment-induced pseudoprogression from recurrent tumor.

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Emblem, K.E., Larsson, C., Groote, I.R., Bjørnerud, A. (2020). MRI Perfusion Techniques. In: Mannil, M., Winklhofer, SX. (eds) Neuroimaging Techniques in Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-48419-4_11

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