Cerebral MR Perfusion Imaging: Principles and Current Applications

This small book contains a tremendous amount of well-written information. It is divided into two large sections. The first section contains technical information about perfusion MR imaging; the second contains information about its clinical uses. There is an excellent reference section, including suggested readings for further detail on methods, clinical applications to stroke and neoplasm, and animal studies. A CD-ROM supplements the book with video clips of cine presentation of image data from patient perfusion studies and postprocessing software tools. The section on technical aspects of perfusion MR imaging is very detailed but is thoughtfully organized and easy to read. Basic cerebral hemodynamic physiology is reviewed, followed by a discussion of the physical basis of contrast material–induced susceptibility effects. This leads into a detailed discussion of all of the practical aspects of performing perfusion studies, including contrast material dose and bolus administration, imaging techniques, and postprocessing. Each step is explained in sufficient detail to allow anyone wishing to perform perfusion studies to do so. Imaging techniques are discussed for echo-planar and non–echo-planar systems and for spin-echo and gradient-echo echo-planar imaging, and tables give specific recommendations for pulse sequence parameters. Most recommendations include the rationale for the recommendation and information on trade-offs involved in selection of parameters and different techniques, allowing the reader to customize them for particular equipment or clinical situations. Numerous well-reproduced graphs and clinical images aid in the explanation of these sometimes difficult concepts. The section on perfusion imaging in clinical practice is equally well presented. The advantages and disadvantages of MR perfusion imaging compared with positron emission tomography and xenon computed tomography are discussed, and this is followed by discussion of use of perfusion MR imaging in the clinical setting of cerebrovascular disease and cerebral neoplasms. Short subsections with mostly preliminary, but interesting, information about perfusion MR in dementia, vasospasm, head trauma, migraine, and epilepsy are also included. Each section is illustrated with high-quality clinical images. The sections on stroke and tumors are more detailed, with background information on the rationale for perfusion imaging, the vascular pathophysiology, and practical clinical uses. The included CD-ROM contains the text and illustrations of the book in digital form, supplementary video clips of perfusion imaging data from clinical images, and a selection of software tools for performing postprocessing on a Unix (LINUX or Solaris) workstation. The video clips do aid the understanding of the technical aspects discussed in the text, but they are certainly not necessary (for those not interested or those who are reading the book away from a computer). I have not used the software tools yet, but I plan to. The authors warn that they are not “user-friendly, commercial-quality” software. The authors and publishers should be very proud of this excellent work. The writing is clear and concise, the illustrations are well chosen and well reproduced, the content is up to date, and the layout and type are perfect. The video clips and software tools are a valuable bonus. Anyone interested in perfusion MR imaging will want this book.