(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.

Special imaging primarily means advanced MRI techniques used for qualitative and quantitative measurement of biological metabolism as e.g., spectroscopy, perfusion imaging (PWI, ASL), diffusion weighted imaging (DWI, DTI, DTT) and brain function (BOLD, fMRI). This physiological magnetic resonance techniques offer insights into brain structure, function, and metabolism.
Spectroscopy provides functional information related to identification and quantification of e.g. brain metabolites. MR perfusion imaging has applications in stroke, trauma, and brain neoplasm. MRI provides the high spatial and temporal resolution needed to measure blood flow to the brain. arterial spin labeling techniques utilize the intrinsic protons of blood and brain tissue, labeled by special preparation pulses, rather than exogenous tracers injected into the blood.
MR diffusion tensor imaging characterizes the ability of water to spread across the brain in different directions. Diffusion parallel to nerve fibers has been shown to be greater than diffusion in the perpendicular direction. This provides a tool to study in vivo fiber connectivity in brain MRI.
FMRI allows the detection of a functional activation in the brain because cortical activity is intimately related to local metabolism changes.

See also 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.

Brain imaging, magnetic resonance imaging of the head or skull, cranial magnetic resonance tomography (MRT), neurological MRI - they describe all the same radiological imaging technique for medical diagnostic.
Magnetic resonance imaging of the human brain includes the anatomic description and the detection of lesions. Special techniques like diffusion weighted imaging, functional magnetic resonance imaging (fMRI) and spectroscopy provide also information about the function and chemical metabolites of the brain. MRI provides detailed pictures of brain and nerve tissues in multiple planes without obstruction by overlying bones. Brain MRI is the procedure of choice for most brain disorders. It provides clear images of the brainstem and posterior brain, which are difficult to view on a CT scan. It is also useful for the diagnosis of demyelinating disorders (disorders such as multiple sclerosis (MS) that cause destruction of the myelin sheath of the nerve).
With this noninvasive procedure also the evaluation of blood flow and the flow of cerebrospinal fluid (CSF) is possible. Different MRA methods, also without contrast agents can show a venous or arterial angiogram. MRI can distinguish tumors, inflammatory lesions, and other pathologies from the normal brain anatomy. However, MRI scans are also used instead other methods to avoid the dangers of interventional procedures like angiography (DSA - digital subtraction angiography) as well as of repeated exposure to radiation as required for computed tomography (CT) and other X-ray examinations.
A (birdcage) bird cage coil achieves uniform excitation and reception and is commonly used to study the brain. Usually a brain MRI procedure includes FLAIR, T2 weighted and T1 weighted sequences in two or three planes.

See also Fetal MRI, Fluid Attenuation Inversion Recovery (FLAIR), Perfusion Imaging and High Field MRI.
See also Arterial Spin Labeling.

Cardiovascular MR imaging includes the complete anatomical display of the heart with CINE imaging of all phases of the heartbeat. Ultrafast techniques make breath hold three-dimensional coverage of the heart in different cardiac axes feasible. Cardiac MRI provides reliable anatomical and functional assessment of the heart and evaluation of myocardial viability and coronary artery disease by a noninvasive diagnostic imaging technique.
Cardiovascular MRI offers potential advantages over radioisotopic techniques because it provides superior spatial resolution, does not use ionizing radiation, has no imaging orientations constraints and contrast resolution better than echocardiography. It also offers direct visualization and characterization of atherosclerotic plaques and diseased vessel walls and surrounding tissues in cardiovascular research.
MRI perfusion approaches measure the alteration of regional myocardial magnetic properties after the intravenous injection of contrast agents and assess the extent of injury after a myocardial infarction and the presence of myocardial viability with a technique based on late enhancement. Extracellular MRI contrast agents, like Gd-DTPA, accumulate only in irreversibly damaged myocardium after a time period of at least 10 minutes.
This type of patients may also have an implanted cardiac stent, bypass or a cardiac pacemaker and special caution should be observed on the MRI safety and the contraindications. While a number of coronary stents have been tested and reported to be MRI compatible, coronary stents must be assessed on an individual basis, with the medical team weighing the risks and benefits of the MRI procedure.

Cardiac MRI overview:

Cardiovascular MRI has become one of the most effective noninvasive imaging techniques for almost all groups of heart and vascular disease.