Korean J Radiol.  2004 Sep;5(3):143-148. 10.3348/kjr.2004.5.3.143.

Perfusion Imaging of the Brain Using Z-Score and Dynamic Images Obtained by Subtracting Images from before and after Contrast Injection

Affiliations
  • 1Department of Diagnostic Radiology, Dong-A University College of Medicine, Korea. sschoi317@yahoo.co.kr
  • 2Department of Radiology, University of Minnesota School of Medicine.

Abstract


OBJECTIVE
The aim of this study was to examine the feasibility of perfusion imaging of the brain using the Z-score and subtraction dynamic images obtained from susceptibility contrast MR images. MATERIALS AND METHODS: Five patients, each with a normal MRI, Moya-moya, a middle cerebral artery occlusion, post-trauma syndrome, and a metastatic brain tumor, were selected for a presentation. A susceptibility-contrast echo-planar image after a routine MRI was taken as the source image with a rapid manual injection of 0.1 mmol/kg of Gd-DTPA. The inflow and washout patterns were observed from the time-signal intensity curve of the serial scans using the standard program of an MRI machine. The repeated Z-score images of the peak and late phases were made using the threshold Z-score values between 1.4 and 2.0 in four to five studies of the pre-contrast, peak, and late phases. Dynamic subtraction images were produced by subtracting sequential post-contrast images from a pre-contrast image and coloring these images using a pseudocolor mapping method. RESULTS: In the diseases with perfusion abnormalities, the Z-score images revealed information about the degree of perfusion during the peak and late phases. However, the quality varied with the Z-score threshold and the studies selected in a group. The dynamic subtraction images were of sufficient quality with no background noise and more clearly illustrated the temporal changes in perfusion and delayed perfusion. CONCLUSION: The Z-scores and dynamic subtraction images illustrated the degree of perfusion and sequential changes in the pattern of perfusion, respectively. These images can be used as a new complimentary method for observing the perfusion patterns in brain diseases.

Keyword

Brain, MR; Brain, blood flow; Magnetic resonance (MR), technology

MeSH Terms

Adult
Brain/*blood supply/radionuclide imaging
Child
Contrast Media
Feasibility Studies
Female
Gadolinium DTPA/diagnostic use
Humans
*Magnetic Resonance Angiography
Male
Middle Aged
Research Support, Non-U.S. Gov't
*Subtraction Technique

Figure

  • Fig. 1 The time-signal intensity curve (right) shows markedly decreased signal intensity during the peak arrival of the contrast agent, followed by the recovery of the signal intensity according to the washout of the contrast media as a function of time at the region of interest (left).

  • Fig. 2 A 26-year-old female with arrhythmia showed a right middle cerebral artery occlusion on the magnetic resonance angiography and high signal intensity at the right basal ganglia on the diffusion weighted image (not shown) 3 hours after developing a left hemiplegia. A. The peak Z-score image shows perfusion defects at the right posterior frontal, temporal area and the basal ganglia. B. The late Z-score image shows delayed perfusion at the perfusion defect areas in A. C. The subtraction dynamic image of a level show initially decreased perfusion with delayed and persisted perfusion at the right frontal, temporal area and the basal ganglia. Images from the top left to the bottom right show the sequential changes in the signal intensity (perfusion) every 1.32 seconds. D. Added images of a peak and a late phase subtraction image show a perfusion defect only at the right basal ganglia (arrow), which is consistent with a diffusion weighted image (not shown).


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