(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.

(3D MRA) The 3D angiography technique can be applied to focus on fast flowing (arterial) blood and to visualize small tortuous vessels. 3D TOF images are less sensitive to turbulent flow artifacts. The advantage of this approach is that the signal, acquired from the entire volume has an increased signal to noise ratio. Slices are defined by a second phase encoded axis, which divides the volume into 'partitions'. 3D TOF MRA is acquired with 3D FT slabs or multiple overlapping thin 3D FT slabs (MOTSA) depending on the coverage required and the range of flow-velocities under examination.
Such 3D techniques can provide equal spatial resolution along all three axes, i.e. be 'isotropic', or the partition thickness can be greater or less than the in plane spatial resolution in which case can be said to be 'anisotropic'. The circle of Willis, anatomy as well as its fast arterial flow, lends itself well to both 3D TOF and 2D or 3D phase contrast angiography.

(ADC) A diffusion coefficient to differentiate T2 shine through effects or artifacts from real ischemic lesions. In the human brain, water diffusion is a three-dimensional process that is not truly random because the diffusional motion of water is impeded by natural barriers. These barriers are cell membranes, myelin sheaths, white matter fiber tracts, and protein molecules.
The apparent water diffusion coefficients can be calculated by acquiring two or more images with a different gradient duration and amplitude (b-values). The contrast in the ADC map depends on the spatially distributed diffusion coefficient of the acquired tissues and does not contain T1 and T2* values.
The increased sensitivity of diffusion-weighted MRI in detecting acute ischemia is thought to be the result of the water shift intracellularly restricting motion of water protons (cytotoxic edema), whereas the conventional T2 weighted images show signal alteration mostly as a result of vasogenic edema.
The reduced ADC value also could be the result of decreased temperature in the nonperfused tissues, loss of brain pulsations leading to a decrease in apparent proton motion, increased tissue osmolality associated with ischemia, or a combination of these factors. The lower ADC measurements seen with early ischemia, have not been fully established, however, a lower apparent ADC is a sensitive indicator of early ischemic brain at a stage when ischemic tissue remains potentially salvageable.

See also Diffusion Weighted Imaging and Diffusion Tensor Tractography.

Short name: B22956, generic name: Gadocoletic acid, chemical compound: Gadocoletic acid trisodium salt, central moiety: Gd, phase: II
A blood pool agent for magnetic resonance coronary angiography and first pass myocardial perfusion imaging under development (Bracco Diagnostics Inc). The small molecules of gadolinium-based B22956 are bound after injection to large human serum albumin molecules in coronary vessels with the result of high vessel/muscle contrast.

Quick Overview
Please note that there are different common names for this artifact.

During frequency encoding, fat protons precess slower than water protons in the same slice because of their magnetic shielding. Through the difference in resonance frequency between water and fat, protons at the same location are misregistrated (dislocated) by the Fourier transformation, when converting MRI signals from frequency to spatial domain. This chemical shift misregistration cause accentuation of any fat-water interfaces along the frequency axis and may be mistaken for pathology. Where fat and water are in the same location, this artifact can be seen as a bright or dark band at the edge of the anatomy.
Protons in fat and water molecules are separated by a chemical shift of about 3.5 ppm. The actual shift in Hertz (Hz) depends on the magnetic field strength of the magnet being used. Higher field strength increases the misregistration, while in contrast a higher gradient strength has a positive effect. For a 0.3 T system operating at 12.8 MHz the shift will be 44.8 Hz compared with a 223.6 Hz shift for a 1.5 T system operating at 63.9 MHz.

For artifact reduction helps a smaller water fat shift (higher bandwidth), a higher matrix, an in phase TE or a spin echo technique. Since the misregistration offset is present in the read out axis the patient may be rescanned with this axis parallel to the fat-water interface. Steeper gradient may be employed to reduce the chemical shift offset in mm. Another strategy is to employ specialized pulse sequences such as fat saturation or inversion recovery imaging. Fat suppression techniques eliminate chemical shift artifacts caused by the lack of fat signal.

See also Black Boundary Artifact and Magnetic Resonance Spectroscopy.