Magnetic resonance: perfusion and diffusion imaging

Summary The use of magnetic resonance imaging to detect normal and pathological problems of perfusion and diffusion is reviewed. Motion sensitised spin-echo images can be used to detect changes in slow flow velocity within a voxel (intravoxel coherent motion (IVCM) as well as intravoxel incoherent motion (IVIM) effects attributable to both diffusion and perfusion. Changes have been identified in a variety of brain diseases in the absence of changes in conventional images but the techniques are very vulnerable to motion artefact of all types. More rapid and more sensitive approaches using steady state free precision and echo-planer imaging are being investigated. Anisotropic diffusion imaging enables white matter tracts to be demonstrated within the brain and spinal cord as a function of their direction because diffusion of water across axons is much more restricted than it is along them. This technique provides a unique method for localisation of lesions and displays obvious changes in disease in which diffusion becomes less restricted.