(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.

(SE) The Reappearance of the MR signal after the FID has apparently died away, as a result of the effective reversal (rephasing) of the dephasing spins by techniques such as specific RF pulse sequences or pairs of field gradient pulses, applied in time shorter than or on the order of T2. Proper selection of the TE time of the pulse sequence can help to control the amount of T1 or T2 contrast present in the image. Pulse sequences of the spin echo type, usually employs a 90° pulse, followed by one or more 180° pulses to eliminate field inhomogeneity and chemical shift effects at the echo. Caused by this 180° refocusing pulse, spin echo or fast spin echo (FSE, TSE) sequences are more robust against e.g. susceptibility artifacts than sequences of the gradient echo type.

(TEeff) The contrast and the SNR of an MR image are determined primarily by the temporal position of the echo at which the phase encoding gradient has the smallest amplitude. The echo signal in this case undergoes minimal dephasing and has the strongest signal. The time period between the excitation pulse and this echo is the effective echo time.

Diffusion weighted imaging can be performed similar to the phase contrast angiography sequence. The gradients must be increased in amplitude to depict the much slower motions of molecular diffusion in the body.
While a T1 weighted MRI pulse sequence is diffusion sensitive, a quantitative diffusion pulse sequence was introduced by Steijskal and Tanner. Its characteristic features are two strong symmetrical gradient lobes placed on either side of the 180° refocusing pulse in a spin echo sequence. These symmetrical gradient lobes have the sole purpose of enhancing dephasing of spins, thereby accelerating intravoxel incoherent motion (IVIM) signal loss.
Dephasing is proportional to the square of the time (diffusion time) during which the gradients are switched on and the strength of the applied gradient field. Therefore, the use of high field gradient systems with faster and more sensitive sequences, make diffusion weighting more feasible.
Areas in which the protons diffuse rapidly (swollen cells in early stroke, less restriction to diffusion) will show an increased signal when the echo is measured relative to areas in which diffusion is restricted. For increased accuracy of diffusion measurement and image enhancement, useful motion correction techniques such as navigator echo and other methods should be used. In addition to this, applying the b-value calculated by the strength and duration of motion probing gradients with a high rate of accuracy is very important.

See also Apparent Diffusion Coefficient, ADC Map, Lattice Index Map.

Fractional echo (also called asymmetric or partial echo) is used to shorten the echo time in a sequence, by acquiring partial echoes in the frequency direction. The reduction of echo time is possible because if the first part of the echo is not received, the dephasing lobe of the frequency encoding gradient is not to be on for quite as long, and this saves time.

See also Partial Fourier Technique, Read Conjugate Symmetry, Single Side View and acronyms for 'fractional echo' from different manufacturers.