Inflow-weighted pulmonary perfusion: comparison between dynamic contrast-enhanced MRI versus perfusion scintigraphy in complex pulmonary circulation

J Cardiovasc Magn Reson. 2013 Feb 28;15(1):21. doi: 10.1186/1532-429X-15-21.


Background: Due to the different properties of the contrast agents, the lung perfusion maps as measured by 99mTc-labeled macroaggregated albumin perfusion scintigraphy (PS) are not uncommonly discrepant from those measured by dynamic contrast-enhanced MRI (DCE-MRI) using indicator-dilution analysis in complex pulmonary circulation. Since PS offers the pre-capillary perfusion of the first-pass transit, we hypothesized that an inflow-weighted perfusion model of DCE-MRI could simulate the result by PS.

Methods: 22 patients underwent DCE-MRI at 1.5T and also PS. Relative perfusion contributed by the left lung was calculated by PS (PS(L%)), by DCE-MRI using conventional indicator dilution theory for pulmonary blood volume (PBV(L%)) and pulmonary blood flow (PBFL%) and using our proposed inflow-weighted pulmonary blood volume (PBV(iw)(L%)). For PBViw(L%), the optimal upper bound of the inflow-weighted integration range was determined by correlation coefficient analysis.

Results: The time-to-peak of the normal lung parenchyma was the optimal upper bound in the inflow-weighted perfusion model. Using PSL% as a reference, PBV(L%) showed error of 49.24% to -40.37% (intraclass correlation coefficient R(I) = 0.55) and PBF(L%) had error of 34.87% to -27.76% (R(I) = 0.80). With the inflow-weighted model, PBV(iw)(L%) had much less error of 12.28% to -11.20% (R(I) = 0.98) from PS(L%).

Conclusions: The inflow-weighted DCE-MRI provides relative perfusion maps similar to that by PS. The discrepancy between conventional indicator-dilution and inflow-weighted analysis represents a mixed-flow component in which pathological flow such as shunting or collaterals might have participated.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Blood Flow Velocity
  • Blood Volume
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / diagnostic imaging
  • Cardiovascular Diseases / physiopathology
  • Child
  • Child, Preschool
  • Collateral Circulation
  • Contrast Media*
  • Female
  • Gadolinium DTPA*
  • Humans
  • Indicator Dilution Techniques
  • Infant
  • Lung / blood supply*
  • Lung Diseases / diagnosis*
  • Lung Diseases / diagnostic imaging
  • Lung Diseases / physiopathology
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Models, Cardiovascular
  • Perfusion Imaging / methods*
  • Predictive Value of Tests
  • Pulmonary Circulation*
  • Radiopharmaceuticals*
  • Regional Blood Flow
  • Time Factors


  • Contrast Media
  • Radiopharmaceuticals
  • Gadolinium DTPA