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Perfusion-weighted magnetic resonance imaging (PWI) encompasses a set of techniques that create images depicting hemodynamics at the microvascular level. PWI offers the opportunity to study the pathophysiological events that lead most directly to ischemic damage. This chapter reviews the techniques employed in PWI with the role of contrast agents, and the MR pulse sequences that are usually chosen. Performing PWI with MRI rather than some other imaging modality offers the theoretical advantage that the contrast agent can be either an endogenous contrast agent that is naturally present in the blood or an exogenous one that is injected for the purpose of obtaining images. PWI techniques are usually designed to rely on gadolinium's susceptibility effect rather than its relaxivity effect, because these effects are exhibited over different ranges. PWI helps to identify tissue that is at risk of inclusion into growing infarcts.
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