Syllabus

Regional perfusion in the tissue can be assessed by following the uptake and washout of the contrast agent in the tissue, using either dynamic contrast enhanced (DCE)-MRI or DCE-CT. Unlike CT, MRI does not use ionizing radiation, which makes it ideal to repeat in longitudinal studies to monitor the disease course or response to treatment.This lecture provides an overview of dynamic contrast-enhanced DCE-MRI acquisition methods and pharmacokinetic models to measure perfusion and permeability, with an emphasis on applications in the liver. DCE-MRI using a gadolinium-based contrast agent allows the quantification of model-free parameters, as well as the quantification of tissue perfusion, permeability, and contrast agent uptake based on pharmacokinetic models. While 4D flow provides vascular flow values (ml/min), DCE-MRI allows an estimation of regional tissue perfusion in ml/min/100g tissue. DCE-MRI uses the unique physiology of liver perfusion (dual input from the hepatic artery and the portal vein) to characterize diffuse liver disease (fibrosis), and conditions arising from end-stage liver disease such as portal hypertension (PH) and hepatocellular carcinoma. DCE-MRI has been shown to capture the pathophysiological changes in the liver caused by fibrosis and PH by measuring prolonged blood transit time of contrast agents in the liver, and the increase in the relative contribution of the hepatic artery vs. the portal vein to total liver flow, described in the literature as the hepatic arterial buffer response (HABR). By attending this lecture, course participants will be introduced to: 1) the conceptual difference between perfusion and vascular permeability, and why it is impossible to measure both at the same time; 2) acquisition protocol requirements for DCE-MRI; 3) the main pharmacokinetic models used with DCE-MRI in diffuse and focal liver disease; 4) examples of clinical applications of DCE-MRI in the liver.

Acknowledgements

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References

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