Perfusion and vascular permeability: basic concepts and measurement in DCE-CT and DCE-MRI

The microvascular network formed by the capillaries supplies the tissues and permits their function. It provides a considerable surface area for exchanges between blood and tissues. All pathological conditions cause changes in the microcirculation. These changes can be used as imaging biomarkers for the diagnosis of lesions and optimisation of treatment. Among the many imaging techniques developed to study the microcirculation, the analysis of the tissue kinetics of intravenously injected contrast agents is the most widely used, either as positive enhancement for CT, T1-weighted MRI and ultrasound - dynamic contrast-enhanced-imaging (DCE-imaging) - or negative enhancement in T2*-weighted brain MRI - dynamic susceptibility contrast-MRI (DSC-MRI) -. Acquisition involves an injection of contrast agent during the acquisition of a dynamic series of images on a zone of interest. These kinetics may be analyzed visually, to define qualitative criteria, or with software using mathematical modelling, to extract quantitative physiological parameters. The results depend on the acquisition conditions (type of imaging device, imaging mode, frequency and total duration of acquisition), the type of contrast agent, the data pre-processing (motion correction, conversion of the signal into concentration) and the data analysis method. Because of these multiple choices it is necessary to understand the physiological processes involved and understand the advantages and limits of each strategy.