Diffusion and Perfusion

MR Imaging
 MRI in Stroke

• Increased sensitivity to stroke relative to

CT
• Equivalent sensitivity for detection of
intraparenchymal hemorrhage
• Conventional MRI may not demonstrate
infarct for 6 hours
 Physiology of Stroke I
• Brain has little capacity to store energy
• Available energy will maintain brain
viability for only 3-4 minutes
• Reduction of flow to below 15-20 ml /
100g of brain tissue / minute will quickly
produce ischemia and result in infarct if
flow is not rapidly restored
 Physiology of Stroke II
• Loss of metabolic substrate leads to failure of
the Na+ / K+ pumps
• This leads to a net movement of water from
the extracellular to the intracellular space
• This produces cell swelling
• This process results in typical cytotoxic
edema seen in infarction
Cell Swelling With Acute
Infarct
 Physiology of Stroke III
The Penumbra
• It is common for acute stroke to progress
• Hypotension, edema, loss of collateral
vessels and further thrombosis of the
supplying vessel may all result in infarction in
the penumbra
• Restoration of flow to the penumbra is the
goal of thrombolytic therapy
Basic Principles of Diffusion

L2 = 2 ∆t D
Where:
L = the translational
displacement
t = time
D = the diffusion coefficient
 Diffusion Coefficient
In MR, an estimate of the tissue diffusion coefficient is
called the apparent diffusion coefficient

L2 = 2 ∆t D
Stejskal-Tanner
Variation of b Values
 ADC Map

ln (Sb/So) = -b (ADC)
 Utility of DWI - Early
detection of Acute Infarct

FLAIR DWI
 Utility of DWI - Acute vs.
Chronic Infarct

T2 FLAIR

DWI ADC
Map
Diffusion Changes With Time
in Cerebral Infarction
Weeks: 1 2 3 4

T2

DWI

ADC
Time Course of ADC and T2
 Perfusion of the Brain
• Delivery of nutrients
• Cerebral blood flow (CBF) normally 60 ml/100g
brain tissue/min
• Cerebral blood volume (CBV) is the fraction of
tissue volume occupied by blood vessels; normally
4%
• Mean Transit Time (MTT) is the time for blood to
travel through the tissue volume normally about 4
seconds
Perfusion Principles

MTT = CBV/CBF

Note similarity

R = V/I
 Measuring CBF
• Labeled microspheres - Gold Standard
– Embolize in capillaries
• Diffusible Tracer
– Freely moves into brain with a partition coefficient λ (if
completely diffusible, λ = 1)
– NO2
– 133 Xe
– 15 O H2O in PET
• Intravascular tracer
– Gadolinium
 Ideal
Perfusion

• --- = arterial concentration

• ƒ = flow
∀ λ = tissue distribution
constant
• CBV = area under curve
 MR Perfusion Imaging
• Rapid, repeated scanning (Echo planar) at a
limited number of slices
• Gradient echo technique (T2*-weighted)
• Gadolinium bolus
• Decrease in signal as Gd passes through
secondary to large magnetic moment and
susceptibility effect
MR Perfusion Principle
 Perfusion Data

• In PET the arterial input can be obtained

(radial artery blood sample) and flow can be
calculated
• With MR perfusion imaging the flow
cannot be directly calculated and the CBV
is only and estimate and is thus termed the
rCBV
 Perfusion Data
• From the perfusion curve that is generated,
the following information can be obtained
– rCBV can be obtained from integration of the
area under the curve
– Although flow cannot be directly measured, the
time to peak (TTP) is proportional to flow
– The peak height is proportional to both the
bolus delivery and the rCBV
Perfusion Maps
 Perfusion in Stroke
• May detect ischemic areas before diffusion
changes
• Identify brain at risk adjacent to infarction
• Allow selection of patients outside the window for
thrombolysis by identifying salvageable brain
• Identify patients with matched perfusion diffusion
defects who likely will not benefit from
thrombolysis
 Perfusion Findings in Acute
Stroke
• rCBV abnormality is usually slightly larger
than diffusion abnormality
• TTP abnormality is bigger than rCBV
• Eventual size of infarct is usually between
rCBV and TTP abnormality
 Unmatched vs. Matched
Diffusion Perfusion Defects
 Other Applications

• Ischemia without infarction

– Toxemia
– Vasospasm
– Cerebral reserve
– Migraine
– Sickle Cell Disease
 Tumor Imaging
• Perfusion imaging assesses the
microvasculature
• Malignant tumors have greater
microvascular supply
• Uses
– Direct biopsy
– Monitor for recurrence
 High Grade Glioma

FDG-PET Gad TTP rCBV

Radiation Necrosis
Recurrent Glioma and
Radiation Necrosis

Gad TTP rCBV

 Functional
Functional MRI
MRI of
of Disease
Disease States
States

Mapping
Mapping of
of lateralization:
lateralization:
Activation
Activation center
center location
location in
in altered
altered brain:
brain:
Presence
Presence and
and impact
impact of
of disease
disease (stroke):
(stroke):
Therapy
Therapy and
and relocalization:
relocalization:
What
What is
is Meant
Meant by
by Functional
Functional MRI?
MRI?
Flow-sensitive MRI - TOF-MRA, PC-MRI

Diffusion-sensitive MRI

Metabolic mapping - MRS

Perfusion mapping with contrast agents

Perfusion "Inflow" MRI "activation

"activation mapping"
mapping"

T2*-sensitive BOLD MRI

Functional
Functional MRI
MRI of
of Disease
Disease States
States

Mapping
Mapping of
of lateralization:
lateralization:
Handedness...
Handedness...
Location
Location of
of foci...
foci...
Seizures
Seizures
Epilepsy
Epilepsy
Tumor
Tumor impact
impact
Stroke
Stroke impact
impact
Central sulcus localization with motor task

X
X
Functional
Functional MRI
MRI of
of Disease
Disease States
States

Mapping of
of localization of
of
Sensori-motor centers :

Tumors // Edema
Edema / Mass
Mass effects
effects
AVM's
Stroke
Trauma

By finger -to-lip control / sensation

activations...
Topics studied
SMR, San using fMRI:
Francisco, 1994:
Language
Language lateralization
lateralization in
in children
children w/
w/ partial
partial seizures,
seizures,
NIH.
NIH.
Long-term
Long-term motor
motor cortex
cortex plasticity,
plasticity,
NIH,
NIH, Inst.
Inst. Neurology
Neurology (London).
(London).
Motor
Motor Recovery
Recovery following
following Cortical
Cortical Stroke,
Stroke,
University
University ofof Essen.
Essen.
Cerebral
Cerebral Oxygenation
Oxygenation in in Carotid
Carotid Occlusive
Occulusive Disease,
Disease,
Biomed.
Biomed. NMRNMR Forschung's
Forschung's GmbH.
GmbH.
Primary/supplementary
Primary/supplementary Motor motor Activation
activation in Hemiplegia,
hemiplegia,
University
University ofof Edinburgh.
Edinburgh.
Cortical
Cortical Processing
Processing during
during Sign
Sign Language
Language in in the
the Deaf,
Deaf,
NIH,
NIH, UWS,
UWS, UCSD,
UCSD, Inst.
Inst. Neurology
Neurology (London).
(London).
Word
Word Production
Production in in Schizophrenics,
Schizophrenics,
Harvard.
Harvard.
Photic
Photic stimulation
stimulation in in Schizophrenics,
Schizophrenics,
Harvard.
Harvard.
Pre-surgical
Pre-surgical Mapping
Mapping of of activation:
activation: Gliomas
Gliomas and
and AVM's,
AVM's,
HUP.
HUP.
More
RSNA,Topics studied:
CHicago, 1994:
Pre-surgical
Pre-surgical Mapping
Mapping ofof Activation,
Activation,
MCW..
MCW..
Olfactory
Olfactory cortical
cortical dysfunction,
dysfunction,
NIH.
NIH.
Regional
Regional Brain
Brain Function
Function and
and AVM
AVM Location,
Location,
HUP.
HUP.
Longitudinal
Longitudinal fMRI
fMRI and
and Progressive
Progressive Neuro
Neuro Disorders,
Disorders,
Berlin.
Berlin.
Hand
Hand Motor
Motor Activation
Activation in
in Congenital
Congenital Mirror
Mirror Movements,
Movements,
Munich.
Munich.
Somatosensory
Somatosensory Localization
Localization and
and Cerebral
Cerebral Tumors,
Tumors,
MCW.
MCW.
 fMRI Is A Question of Hemodynamics
T2* vs. Proton Inflow

BOLD fMRI relates arterial Inflow fMRI depends

to bulk T2* within on delivery of arterial
a slice. Alterations protons into an
in T2* can be imaged slice -
caused by: induced altered
Imaged slice magnetization by:
∆ CBV
∆ CBF ∆ CBF
∆ Oxygen usage/
extraction
∆ Metabolism

venous
 MR Task Activation of the Human Visual Cortex
GE Signa Placement of Oblique Slice
SPGR
TR 75
TE 60
2 NEX
20 sec
128X256
40 flip
5 mm
24 FOV
surface coil

LED
excitation
10 Hz

Tsukamoto
Moseley
de Crespigny
et al.
YMS- UCSF
 MR Task Activation of the Human Visual Cortex

Mask (2 NEX) Effect of activation

Tsukamoto
Moseley
de Crespigny
et al.
YMS- UCSF
 MR Task Activation of the Human Visual Cortex
1.04
Visual cortex
1.03

% Change
1.02

1.01 Brain

1.00

3.5 minutes
Tsukamoto 0.99
0 10 20 30
Moseley
de Crespigny
et al. Image Number (x 10 seconds)
YMS- UCSF
 Task Activation of Visual Cortex by MRI
GE 1.5T, Spiral MRI
Oblique thro V1 with surface coil

T1 T2 Spiral

Glover, Lee, et al. Stanford

 Task Activation of Visual Cortex by MRI

8 images of a train of 252 over 6 minutes

Raw images, 188x188, 1.5 second scans, 20 spirals

Glover, Lee, et al. Stanford

 Task Activation of Visual Cortex by MRI

"Paradigm"
16

12

%
4

"Response"
0

-4

-8

-12
0 40 80 120 160 200 240
Image Number
1- 252 = 6 minutes
Approximate stimulus as a sinusoid. Calculate r.
y = S sin(iwt + phase) + constant

MR signal

R=0.8 time

Correlation coefficient, R==

 Task Activation of Visual Cortex by MRI
GE 1.5T, Spiral MRI
Oblique thro V1 with surface coil

T1 Spiral Correlation
function

Glover, Lee, et al. Stanford

 Optical Imaging
Diffuse Optical Tomography - DOT
Informs about concentrations of Hb in
arterial, capillary, venial compartments.

Sensitive to total optical absorption by

HbO and Hb at two wavelengths.
--> 2 measurements, 2 unknowns.
Animal model or neurosurgical microscopy.
Temporal resolution 0.1 mm possible.
 Optical Imaging

Bonhoeffer & Grinvald, Brain Mapping: The Methods, 1996, Eds Toga & Mazziota.