MR perfusion of the brain is an advanced technique used to study cerebral blood volume, cerebral blood flow, mean transit time and time to peak among other cerebral circulation parameters which is used to:
Assess the size of the necrotic core and ischemic penumbra in acute cerebrovascular ischemic stroke patients and assess the need for neuro-vascular intervention accordingly.
Help in differentiating brain inflammatory & infectious conditions e.g. tumefactive MS and cerebral tubercloma from brain tumors.
Help in assessing tumoral grade and response to therapy based on changes in cerebral blood volume and flow to the tumoral tissues
Some acute cerebrovascular ischemic stroke patients to assess the size of the necrotic core and ischemic penumbra which help in deciding the utility of endovascular intervention e.g. clot retrieval or vascular stenting.
Patient’s with uncharacterized brain lesion to help in differentiating brain inflammatory & infectious conditions e.g. tumefactive MS and cerebral tubercloma from brain tumors.
Brain tumors’ patients especially post radiotherapy & chemotherapy patients.
Some cases with neuro-degenerative diseases e.g. Alzheimer disease
Patients with mechanically/magnetically activated devices as cardiac pacemaker, cochlear implants.
Patients with metallic foreign body in the eye.
Pregnant women in the first trimester (benefits versus risk to be assessed).
Ferromagnetic surgical clips or prosthesis
In case of stroke patients, and in order to fully assess the location and extension of the damaged brain parenchyma, as well as state of cerebral circulation, your doctor may one or combination of the following:
MRI stroke protocol
Full MRI examination of the brain
MR angiography (MRA) of the cerebral arteries.
In case of brain tumor patients, and according to the specifics of the patient’s condition, Your doctor may request one or more of the following MRI ± CT examinations:
Full MRI examination of the brain as well as MR angiography (MRA)/ MR venography (MRV) of the cerebral arteries/veins to assess full extension of the tumor and its vascular relations.
MR spectroscopy (MRS) to evaluate tumor grade and response to treatment e.g. radiotherapy.
Functional MRI (fMRI) to localize vital motor and speech brain centers in relation to tumor.
Diffusion tensor imaging (DTI) to assess relation between tumor and major white matter tracts.
MRI brain lab. protocol to guide the 3D co-ordinate system used for neuro-surgery or radiotherapy.
PET-CT examination to rule out extra-cranial tumors.
CT brain or CT sella to evaluate bony extensions of the tumor in relation to skull bones, paranasal sinuses or bony orbit which is optimally demonstrated by CT.
CT angiographic examination of the cerebral vessels to assess the tumor related arteries and veins
The examination is usually done using intravenous contrast material:
Patient should be food fasting 4-6 hours before the exam.
Adequate hydration at least one day before and after the exam is needed.
Recent kidney function test should be available at the time of your examination.
The examination could be done without contrast using arterial spin labelling technique (ASL) but the quantitative analysis of the brain perfusion will be limited to cerebral blood flow data (CBF).
In case of claustrophobic patients, the examination can be done under anesthesia.
In case of contrast enhanced study drinking plenty of water is advised to help to wash out the injected IV contrast material out of your body except if you are on fluid balance for renal or cardiac condition you may consult your physician and in case of lactating mothers it is advised to escape lactation for 24 hrs after the contrast injection.
No after care or precautions needed following non contrast enhanced study