(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.

Cine sequences used in cardiovascular MRI are collection of images (usually at the same spatial location) covering of one full period of cardiac cycle or over several periods in order to obtain complete coverage.
The pulse sequence used, is either a standard gradient echo pulse sequence, a segmented data acquisition, a gradient echo EPI sequence or a gradient echo with balanced gradient waveform. In cardiac gating studies it is possible to assign consecutive lines either to different images, yielding a multiphase sequence with as many images as lines, or the lines are grouped together into segments and assigned to the same image. The overall time to acquire such a segment has to be small compared to the RR-interval of the cardiac cycle, i. e. 50 ms, and hence contains typically 8 to 16 image lines.
This strategy is called segmented data acquisition, and has the advantage of reducing overall imaging time for cardiac images so that they can be acquired within a breath hold, but obviously decreasing the temporal resolution of each individual image. This method shows dynamic processes, such as the ejection of blood out of the heart into the aorta, by means of fast imaging and displaying the resulting images in a sequential-loop, the impression of a real-time movie is generated. Ejection fractions and stroke volumes calculated from these cine MRI images in different cardiac axes have been shown to be more accurate than any other imaging modality.

See also Cardiac Gating.