Arterial input function in perfusion MRI: a comprehensive review

Cerebral perfusion, also referred to as cerebral blood flow (CBF), is one of the most important parameters related to brain physiology and function. The technique of dynamic-susceptibility contrast (DSC) MRI is currently the most commonly used MRI method to measure perfusion. It relies on the intravenous injection of a contrast agent and the rapid measurement of the transient signal changes during the passage of the bolus through the brain. Central to quantification of CBF using this technique is the so-called arterial input function (AIF), which describes the contrast agent input to the tissue of interest. Due to its fundamental role, there has been a lot of progress in recent years regarding how and where to measure the AIF, how it influences DSC-MRI quantification, what artefacts one should avoid, and the design of automatic methods to measure the AIF. The AIF is also directly linked to most of the major sources of artefacts in CBF quantification, including partial volume effect, bolus delay and dispersion, peak truncation effects, contrast agent non-linearity, etc. While there have been a number of good review articles on DSC-MRI over the years, these are often comprehensive but, by necessity, with limited in-depth discussion of the various topics covered. This review article covers in greater depth the issues associated with the AIF and their implications for perfusion quantification using DSC-MRI.