Quantification of relative cerebral blood flow change by flow-sensitive alternating inversion recovery (FAIR) technique: application to functional mapping

Quantitative imaging of perfusion using a single subtraction (QUIPSS and QUIPSS II)

In the pulsed arterial spin labeling (ASL) techniques EPISTAR, PICORE, and FAIR, subtraction of two images in which inflowing blood is first tagged and then not tagged yields a qualitative map of perfusion. An important reason this map is not quantitative is that there is a spatially varying delay in the transit of blood from the tagging region to the imaging slice that cannot be measured from a single subtraction. We introduce here two modifications of pulsed ASL (QUIPSS and QUIPSS II) that avoid this problem by applying additional saturation pulses to control the time duration of the tagged bolus, rendering the technique relatively insensitive to transit delays and improving the quantitation of perfusion.

Quantitative measurements of cerebral blood flow in rats using the FAIR technique: correlation with previous iodoantipyrine autoradiographic studies

Flow-sensitive alternating inversion recovery (FAIR) is a recently introduced MRI technique for assessment of perfusion that uses blood water as an endogenous contrast agent. To characterize the FAIR signal dependency on spin tagging time (inversion time (TI)) and to validate FAIR for cerebral blood flow (CBF) quantification, studies were conducted on the rat brain at 9.4 T using a conventional gradient-recalled echo sequence. The T1 of cerebral cortex and blood was found to be 1.9 and 2.2 s, respectively, and was used for CBF calculations. At short TIs (<0.8 s), the FAIR signal originates largely from vascular components with fast flows, resulting in an overestimation of CBF. For TI > 1.5 s, the CBF calculated from FAIR is independent of the spin tagging time, suggesting that the observed FAIR signal originates predominantly from tissue/capillary components. CBF values measured by FAIR with TI of 2.0 s were found to be in good agreement with those measured by the iodoantipyrine technique with autoradiography in rats under the same conditions of anesthesia and arterial pCO2. The measured pCO2 index on the parietal cortex using the FAIR technique was 6.07 ml/100 g/min per mmHg, which compares well with the pCO2 index measured by other techniques. The FAIR technique was also able to detect the regional reduction in CBF produced by middle cerebral artery occlusion in rats.

Simultaneous multislice acquisition with arterial-flow tagging (SMART) using echo planar imaging (EPI)

Arterial spin tagging techniques have been used to image tissue perfusion in MR without contrast injection or ionizing radiation. Currently, spin tagging studies are performed primarily using single-slice imaging sequences, which are time consuming. This note reports a multislice echo-planar arterial spin tagging technique (Simultaneous Multislice Acquisition with aRterial-flow Tagging, or "SMART"). Multiband RF encoding (Hadamard) is used to provide simultaneous multislice acquisition capability for spin tagging techniques (such as echo planar imaging signal targeting with alternating radio frequency and flow-sensitive alternative inversion recovery). The method is illustrated with a two-slice pulse sequence that was implemented using the FAIR technique to generate two perfusion weighted images simultaneously. Compared with single-slice sequences, this two-slice sequence provided similar image quality, signal-to-noise ratio, and twice the spatial coverage compared with the single-slice technique within the same scan time.

Activation of visuomotor systems during visually guided movements: a functional MRI study

The dorsal stream is a dominant visuomotor pathway that connects the striate and extrastriate cortices to posterior parietal areas. In turn, the posterior parietal areas send projections to the frontal primary motor and premotor areas. This cortical pathway is hypothesized to be involved in the transformation of a visual input into the appropriate motor output. In this study we used functional magnetic resonance imaging (fMRI) of the entire brain to determine the patterns of activation that occurred while subjects performed a visually guided motor task. In nine human subjects, fMRI data were acquired on a 4-T whole-body MR system equipped with a head gradient coil and a birdcage RF coil using a T2*-weighted EPI sequence. Functional activation was determined for three different tasks: (1) a visuomotor task consisting of moving a cursor on a screen with a joystick in relation to various targets, (2) a hand movement task consisting of moving the joystick without visual input, and (3) a eye movement task consisting of moving the eyes alone without visual input. Blood oxygenation level-dependent (BOLD) contrast-based activation maps of each subject were generated using period cross-correlation statistics. Subsequently, each subject's brain was normalized to Talairach coordinates, and the individual maps were compared on a pixel by pixel basis. Significantly activated pixels common to at least four out of six subjects were retained to construct the final functional image. The pattern of activation during visually guided movements was consistent with the flow of information from striate and extrastriate visual areas, to the posterior parietal complex, and then to frontal motor areas. The extensive activation of this network and the reproducibility among subjects is consistent with a role for the dorsal stream in transforming visual information into motor behavior. Also extensively activated were the medial and lateral cerebellar structures, implicating the cortico-pontocerebellar pathway in visually guided movements. Thalamic activation, particularly of the pulvinar, suggests that this nucleus is an important subcortical target of the dorsal stream.

Calibrated functional MRI: mapping the dynamics of oxidative metabolism

MRI was extended to the measurement of changes in oxidative metabolism in the normal human during functionally induced changes in cellular activity. A noninvasive MRI method that is model-independent calibrates the blood oxygen level dependent (BOLD) signal of functional MRI (fMRI) against perfusion-sensitive MRI, using carbon dioxide breathing as a physiological reference standard. This calibration procedure provides a regional measurement of the expected sensitivity of the fMRI BOLD signal to changes in the cellular activity of the brain. Maps of the BOLD signal calibration factor showed regional heterogeneity, indicating that the magnitude of functionally induced changes in the BOLD signal will be dependent on both the local change in blood flow and the local baseline physiology of the cerebral cortex. BOLD signal magnitude is shown to be reduced by 32% from its expected level by the action of oxygen metabolism. The calibrated fMRI technique was applied to stimulation of the human visual cortex with an alternating radial checkerboard pattern. With this stimulus oxygen consumption increased 16% whereas blood flow increased 45%. Although this result is consistent with previous findings of a significant difference between the increase in blood flow and oxygen consumption, it does indicate clearly that oxidative metabolism is a significant component of the metabolic response of the brain to functionally induced changes in cellular activity.

Functional MRI using steady-state arterial water labeling

Flow-sensitive functional MRI (fMRI) was performed using steady-state arterial water labeling (SS-AWL). Arterial water labeling was accomplished by flow induced adiabatic fast passage. The signal intensity of the visual cortex in arterial water labeled images decreased by approximately 1.4% during visual stimulation of the brain. Acquisition of arterial water unlabeled and labeled images allows measurement of relative cerebral blood flow increase during brain activation. During visual stimulation, cerebral blood flow in the visual cortex increased by 17 to 35% as measured by SS-AWL. Quantitation of brain activation in terms of a physiological parameter using SS-AWL will facilitate comparative fMRI studies under different conditions.

A functional MRI study of subjects recovered from hemiparetic stroke

BACKGROUND AND PURPOSE

Stroke recovery mechanisms remain incompletely understood, particularly for subjects with cortical stroke, in whom limited data are available. We used functional magnetic resonance imaging to compare brain activations in normal controls and subjects who recovered from hemiparetic stroke.

METHODS

Functional magnetic resonance imaging was performed in ten stroke subjects with good recovery, five with deep, and five with cortical infarcts. Brain activation was achieved by index finger-tapping. Statistical parametric activation maps were obtained using a t test and a threshold of P < .001. In five bilateral motor regions, the volume of activated brain for each stroke subject was compared with the distribution of activation volumes among nine controls.

RESULTS

Control subjects activated several motor regions. During recovered hand finger-tapping, stroke subjects activated the same regions as controls, often in a larger brain volume. In the unaffected hemisphere, sensorimotor cortex activation was increased in six of nine stroke subjects compared with controls. Cerebellar hemisphere contralateral and premotor cortex ipsilateral to this region, as well as supplementary motor areas, also had increased activation. In the stroke hemisphere, activation exceeding controls was uncommon, except that three of five cortical strokes showed peri-infarct activation foci. During unaffected hand finger-tapping, increased activation by stroke subjects compared with controls was uncommon; however, decreased activation was seen in unaffected sensorimotor cortex, suggesting that this region's responsiveness increased to the ipsilateral hand and decreased to contralateral hand movements. Use of a different threshold for defining activation (P < .01) did not change the overall findings (kappa = .75).

CONCLUSIONS

Recovered finger-tapping by stroke subjects activated the same motor regions as controls but to a larger extent, particularly in the unaffected hemisphere. Increased reliance on these motor areas may represent an important component of motor recovery. Functional magnetic resonance imaging studies of subjects who recovered from stroke provide evidence for several processes that may be related to restoration of neurologic function.

Slice profile effects in adiabatic inversion: application to multislice perfusion imaging

Imperfections in the slice profile of the adiabatic inversion induced by relaxation effects are shown to cause signal variations in pulsed arterial tagging schemes on the order of magnitude of perfusion changes, and result in gross errors in perfusion quantitation. Significant improvement can be made with minor modifications to the inversion pulse which facilitate the acquisition of quantitative, multislice perfusion images, as demonstrated in both a phantom and a normal human volunteer.

STAR-HASTE: perfusion imaging without magnetic susceptibility artifact

A novel magnetic resonance imaging technique (STAR-HASTE) based on pulsed arterial spin labeling using a single shot acquisition method is described for perfusion imaging. The method is similar to EPISTAR in using STAR (Signal Targeting with Alternating Radiofrequency) technique for pulsed radiofrequency labeling of inflowing blood, but uses a half-Fourier single shot turbo spin-echo (HASTE) sequence for data acquisition instead of echo-planar imaging (EPI). Our preliminary studies show that STAR-HASTE permits perfusion imaging to be performed without many of the artifacts encountered with other imaging methods based on EPI acquisition. The novel method not only provides similar perfusion information to that obtained by EPISTAR, as demonstrated in the functional brain imaging study, but also eliminates magnetic susceptibility artifacts and image distortion commonly observed in EPI images. Furthermore, this technique can be readily implemented in MR systems without EPI capability.

Evidence for the exchange of arterial spin-labeled water with tissue water in rat brain from diffusion-sensitized measurements of perfusion

The extraction fraction of vascular water in rat brain is investigated by means of diffusion measurements of arterial spin labeled water at varying cerebral blood flow (CBF) values. The apparent diffusion coefficient (ADC) of the difference of the proton magnetization signal in the brain acquired with and without continuous arterial spin labeling is modeled to provide a measure of the amount of arterial water in tissue and vasculature and thus of the extraction fraction. The tissue and vascular portion of the arterial spin labeled water are differentiated based on their diffusion characteristics in a manner analogous to the intravoxel incoherent motion (IVIM) method. The amount of labeled arterial water that exchanges with tissue water is determined by estimating the fraction of the total signal that is associated with the slow-decaying component of a biexponential fit to the normalized difference signal between the magnetization of brain tissue acquired with and without arterial spin labeling. The results indicate that, at normal CBF (1.15 +/- 0.21 ml x g(-1) x min[-1]), about 90% of the arterial spin labeled water diffuses with an ADC of (1.21 +/- 0.37) x 10[-3] mm2 s[-1]), which is equal to tissue. At high CBF, an increasing fraction of the labeling water has a fast-pseudo-diffusion coefficient due to a decrease in water extraction fractions. The results also show that the contribution of vascular water to the measurement of perfusion by techniques that use endogenous water as a tracer can be efficiently eliminated by the use of diffusion sensitizing gradients with small effective b values (b approximately 20 s/mm2), enabling these techniques to monitor true changes in tissue perfusion.

Quantitation of regional cerebral blood flow increases during motor activation: a steady-state arterial spin tagging study

Steady-state arterial spin tagging MRI approaches were used to quantitate regional cerebral blood flow increases during finger tapping tasks in seven normal subjects. Statistically significant increases in cerebral blood flow were observed in the contralateral primary sensorimotor cortex in all seven subjects and in the supplementary motor area in five subjects. The intrinsic spatial resolution of the cerebral blood flow images was approximately 4 mm. If no spatial filtering was applied, the average increase in cerebral blood flow in the activated primary sensorimotor cortex was 60 +/- 10 cc/100 g/min (91 +/- 32%). If the images were filtered to a spatial resolution of 15 mm, the average increase in cerebral blood flow in the activated primary sensorimotor cortex was 23 +/- 7 cc/100 g/min (42 +/- 15%), in agreement with previously reported 133Xe and PET results.

Comparison of blood oxygenation and cerebral blood flow effects in fMRI: estimation of relative oxygen consumption change

The most widely-used functional magnetic resonance imaging (fMRI) technique is based on the blood oxygenation level dependent (BOLD) effect, which requires at least partial uncoupling between cerebral blood flow (CBF) and oxygen consumption changes during increased mental activity. To compare BOLD and CBF effects during tasking, BOLD and flow-sensitive alternating inversion recovery (FAIR) images were acquired during visual stimulation with red goggles at a frequency of 8 Hz in an interleaved fashion. With the FAIR technique, absolute and relative CBF changes were determined. Relative oxygen consumption changes can be estimated using the BOLD and relative CBF changes. In gray matter areas in the visual cortex, absolute and relative CBF changes in humans during photic stimulation were 31 +/- 11 SD ml/100 g tissue/min and 43 +/- 16 SD % (n = 12), respectively, while the relative oxygen consumption change was close to zero. These findings agree extremely well with previous results using positron emission tomography. The BOLD signal change is not linearly correlated with the relative CBF increase across subjects and negatively correlates with the oxygen consumption change. Caution should be exercised when interpreting the BOLD percent change as a quantitative index of the CBF change, especially in inter-subject comparisons.

Functional magnetic resonance imaging of the human brain

The current technical and methodological status of functional magnetic resonance imaging (fMRI) is reviewed. The mechanisms underlying the effects of deoxyhemoglobin concentration and cerebral blood flow changes are discussed, and methods for monitoring these changes are described and compared. Methods for post-processing fMRI data are outlined. Potential problems and solutions related to vessels and motion are discussed in detail.

Methods for assessing accuracy and reliability in functional MRI

In this paper, methods for assessing the accuracy and the reliability of functional magnetic resonance imaging techniques are presented. First, a modified receiver operating characteristic analysis is described for evaluating the accuracy of fMRI studies. With this modified approach, the true positives or the activated pixels are estimated based on highly averaged experimental data acquired with the same stimulation/task. Unlike ROC analysis based on simulated activation data, the present approach can be applied to experimentally acquired data without simplifying the activation related changes. To assess the reliability of fMRI studies, the kappa statistic was adopted for evaluating the overall agreement of functional activation maps from repeated experiments in individual subjects. To demonstrate the utility of these techniques, both the ROC analysis and the reliability assessment were applied to quantitatively evaluate the improvement in accuracy and reliability of a retrospective technique for physiological noise reduction in fMRI.

Multi-slice perfusion-based functional MRI using the FAIR technique: comparison of CBF and BOLD effects

Perfusion-weighted imaging techniques employing blood water protons as an endogenous tracer have poor temporal resolution because each image should be acquired with an adequate spin 'tagging' time. Thus, perfusion-based functional magnetic resonance imaging studies are typically performed on a single slice. To alleviate this problem, a multi-slice flow-sensitive alternating inversion recovery technique has been developed. Following a single inversion pulse and a delay time, multi-slice echo-planar images are acquired sequentially without any additional inter-image delay. Thus, the temporal resolution of multi-slice FAIR is almost identical to that of single slice techniques. The theoretical background for multi-slice FAIR is described in detail. The multi-slice FAIR technique has been successfully applied to obtain three-slice cerebral blood flow based functional images during motor tasks. The relative CBF change in the contralateral motor/sensory area during unilateral thumb-digit opposition is 45.0+/-12.2% (n=9), while the blood oxygenation level dependent signal change is 1.5+/-0.4 SD%. Relative changes of the oxygen consumption rate can be estimated from CBF and BOLD changes using FAIR. The BOLD signal change is not correlated with the relative CBF increase, and thus caution should be exercised when interpreting the BOLD change as a quantitative index of the CBF change, especially in inter-subject comparisons.

Time-resolved measurements of brain activation after a short visual stimulus: new results on the physiological mechanisms of the cortical response

This paper presents examinations of the time course of the signal from the visual cortex following a brief (2 s) light stimulus. Signal was generated from a 2 x 2 x 2 ml voxel using a modified point-resolved spectroscopy experiment. In accordance with previous studies a triphasic time course was observed. The results indicate that the observable signal contains contributions from non blood oxygen level dependent signal changes occurring immediately after the onset of stimulation. The response to multiple stimuli could be fitted with a response model which is linear with respect to the BOLD-phase of the response. This suggests that the experiments using a very weak stimulus were performed below the limit of the arterial reserve. This is in marked contrast to other studies performed by functional magnetic resonance imaging as well as optical imaging. First results using echo planar imaging confirm the common origin of the signals in the activated cortical areas.

Simultaneous assessment of flow and BOLD signals in resting-state functional connectivity maps

We have recently demonstrated using functional magnetic resonance imaging the presence of synchronous low-frequency fluctuations of signal intensities from the resting human brain that have a high degree of temporal correlation (p < 0.0001) both within and across the sensorimotor cortex. A statistically significant overlap between the resting-state functional connectivity map and the task-activation map due to bilateral finger tapping was obtained. Similar results have been obtained in the auditory and visual cortex. Because the pulse sequence used for collecting data was sensitive to blood flow and blood oxygenation, these low-frequency fluctuations of signal intensity may have arisen from variations of both. The objective of this study was simultaneously to determine the contribution of the blood oxygenation level signal and the flow signal to physiological fluctuations in the resting brain using the flow-sensitive alternating inversion recovery pulse sequence. In all subjects, the functional connectivity maps obtained from BOLD had a greater coincidence with task-activation maps than the corresponding functional connectivity maps obtained from blood-flow signals at the same level of statistical significance. Results of this study suggest that while variations in blood flow might contribute to functional connectivity maps, BOLD signals play a dominant role in the mechanism that gives rise to functional connectivity in the resting human brain.

Perfusion imaging by a flow-sensitive alternating inversion recovery (FAIR) technique: application to functional brain imaging

Perfusion is a crucial physiological parameter for tissue function. To obtain perfusion-weighted images and consequently to measure cerebral blood flow (CBF), a newly developed flow-sensitive alternating inversion recovery (FAIR) technique was used. Dependency of FAIR signal on inversion times (TI) was examined; signal is predominantly located in large vessels at short TI, whereas it is diffused into gray matter areas at longer TI. CBF of gray matter areas in the human brain is 71 +/- 15 SD ml/100 g/min (n = 6). In fMRI studies, micro- and macrovessel inflow contributions can be obtained by adjusting TIs. Signal changes in large vessel areas including the scalp were seen during finger opposition at a TI of 0.4 s; however, these were not observed at a longer TI of 1.4 s. To compare with commonly used BOLD and slice selective inversion recovery techniques, FAIR and BOLD images were acquired at the same time during unilateral finger opposition. Generally, activation sites determined by three techniques are consistent. However, activation of some areas can be detected only by FAIR, not by BOLD, suggesting that the oxygen consumption increase couples with the CBF change completely. Relative and absolute CBF changes in the contralateral motor cortex are 53 +/- 17% SD (n = 9) and 27 +/- 11 SD ml/100 g/min (n = 9), respectively.

Estimation of water extraction fractions in rat brain using magnetic resonance measurement of perfusion with arterial spin labeling

The model used for calculating perfusion by MRI techniques that use endogenous water as a tracer assumes that arterial water is a freely diffusible tracer. Evidence shows that this assumption is not valid in the brain at high blood flow rates, at which movement of water into and out of the microvasculature becomes limited by diffusion across the blood-brain barrier. In this work, the arterial spin-labeling technique is used to show that fraction of arterial water that is dependent on blood flow rate remains in the vasculature and does not exchange with brain tissue water. By using perfusion measurements without and with magnetization transfer (MT) effects, one can distinguish arterial label that exchanges into tissue because blood has much smaller MT than brain tissue. Using this technique, the extraction fraction for water is measured in the rat brain at various cerebral blood flow rates. At high flow rates (approximately 5 ml/g/min), the extraction fraction for water is found to be about 45% in rat brain. Disruption of the blood-brain barrier with D-mannitol caused an increase in the extraction fraction for water. It was possible to form an image related to the extraction fraction for water. The ability to estimate the amount of vascular water exchanging with tissue water by MRI may represent a noninvasive approach to detect the integrity of the blood-brain barrier.

Perfusion imaging by un-inverted flow-sensitive alternating inversion recovery (UNFAIR)

A new pulse sequence for estimating cerebral blood flow called UNFAIR, which uses a combination of sequential hyperbolic secant preparatory pulses, is introduced. This sequence is based on the same generalized conditions as previously introduced inversion recovery techniques except that the spins in the image slice of interest always have +z magnetization and the in-flowing spins are alternately inverted and uninverted. CBF-weighted images of rat brain under conditions of normocpnia and hypercapnia are presented and demonstrate the expected CBF response. A model describing the signal response to this pulse sequence is also presented and compared with in-vivo data acquired from gray and white matter.

Reduced transit-time sensitivity in noninvasive magnetic resonance imaging of human cerebral blood flow

Herein, we present a theoretical framework and experimental methods to more accurately account for transit effects in quantitative human perfusion imaging using endogenous magnetic resonance imaging (MRI) contrast. The theoretical transit time sensitivities of both continuous and pulsed inversion spin tagging experiments are demonstrated. We propose introducing a delay following continuous labeling, and demonstrate theoretically that introduction of a delay dramatically reduces the transit time sensitivity of perfusion imaging. The effects of magnetization transfer saturation on this modified continuous labeling experiment are also derived, and the assumption that the perfusion signal resides entirely within tissue rather than the arterial microvasculature is examined. We present results demonstrating the implementation of the continuous tagging experiment with delay on an echoplanar scanner for measuring cerebral blood flow (CBF) in normal volunteers. By varying the delay, we estimate transit times in the arterial system, values that are necessary for assessing the accuracy of our quantification. The effect of uncertainties in the transit time from the tagging plane to the arterial microvasculature and the transit time to the tissue itself on the accuracy of perfusion quantification is discussed and found to be small in gray matter but still potentially significant in white matter. A novel method for measuring T1, which is fast, insensitive to contamination by cerebrospinal fluid, and compatible with the application of magnetization transfer saturation, is also presented. The methods are combined to produce quantitative maps of resting and hypercarbic CBF.

Frequency offset corrected inversion (FOCI) pulses for use in localized spectroscopy

Gradient localized spectroscopy techniques suffer from a well documented spatial localization error caused by the difference in chemical shifts between resonances. This results in the acquisition of spectra from partially overlapping spatial regions of the sample, with each resonance representing a different region. The image-selected in vivo spectroscopy technique uses hyperbolic secant inversion pulses, where the main limitation in reducing this error is in the RF power available for application of the selective RF pulse. This spatial localization error may be dramatically reduced by increasing, and temporally shaping, the gradient pulse during slice-selective spin inversion. The performance of these RF pulses have been experimentally verified.

Perfusion imaging of the human brain at 1.5 T using a single-shot EPI spin tagging approach

Single-shot echo planar imaging (EPI) techniques have been applied, in conjunction with arterial spin tagging approaches, to obtain images of cerebral blood flow in a single axial slice in the human brain. Serial studies demonstrate that cerebral blood flow images acquired in 8 min are reproducible, with a statistical precision of approximately +/-10 cc/100 g/min. The average value of cerebral blood flow in the slice is 51 +/- 11 cc/100 g/min for six normal subjects. The cerebral blood flow images contain two types of artifact, probably due to arterial and venous blood volume contributions, which must be overcome before the arterial spin tagging approach can be used for routine clinical studies.

Quantitative cardiac perfusion: a noninvasive spin-labeling method that exploits coronary vessel geometry

PURPOSE

To quantitate myocardial arterial perfusion with a noninvasive magnetic resonance (MR) imaging technique that exploits the geometry of coronary vessel anatomy.

MATERIALS AND METHODS

MR imaging was performed with a spin-labeling method in six arrested rabbit hearts at 4.7 T. Selective inversion of magnetization in the short-axis imaging section along with all myocardium apical to that section produces signal enhancement from arterial perfusion. A linescan protocol was used for validation of flow enhancement. Flow was quantitated from two images and validated with spin-echo (SE) imaging. Regional perfusion defects were created by means of coronary artery ligation and delineated with gadolinium-enhanced imaging.

RESULTS

Linescan estimates of T1 obtained at physiologic flows agreed with model predictions. Flow-induced signal enhancement measured on SE images also agreed with expected values. Finally, perfusion abnormalities created by means of coronary artery ligation were detected.

CONCLUSION

This spin-labeling method provides quantitative estimates of myocardial arterial perfusion in this model and may hold promise for clinical applications.

A model for quantification of perfusion in pulsed labelling techniques

A model for quantification of perfusion in pulsed labelling techniques is described, based on solving the modified Bloch equation including the effects of flow. The model is designed to fit experimental data acquired in two separate measurements (inversion and control, or selective and non-selective inversions) for different inversion times using a biexponential. Although the signal contrast is 50% less than the continuous labelling technique, it seems more appropriate for human studies because of its lower power deposition, shorter transit time and the use of an interleaved acquisition. The importance is shown of including in the model the difference in relaxation time between blood and tissue. Neglecting this difference can lead to an overestimation of flow, which can be as big as 100% in white matter and 20% in grey matter.