Clinical Applications of Dynamic Contrast-Enhanced (DCE) Permeability Imaging

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) is an MRI perfusion technique that calculates perfusion parameters by evaluating the concentration of a gadolinium-based contrast agent (GBCA) in tissue as a function of time after bolus injection of GBCA. The most commonly calculated parameter is Ktrans, the volume transfer constant describing the rate of flux of contrast agent into the extravascular-extracellular space. DCE MRI has been mainly used for clinical application in brain tumors, as the possibility to obtain information about vascular hemodynamics allowed to noninvasively characterize neoplastic lesions, improving diagnostic accuracy and ultimately leading to appropriate treatment decisions and increased probability of better patient outcomes. However, despite newer imaging and post-processing techniques, the full application of DCE MRI into routine clinical setting is still challenging. In this chapter, we review the main clinical applications of DCE MRI, present results from studies showing the advantages and pitfalls of this technique, and provide examples of perfusion techniques applied to patients. Current challenges and future perspectives are also described.