PIANO: Perfusion Imaging via Advection-Diffusion

Perfusion imaging (PI) is clinically used to assess strokes and brain tumors. Commonly used PI approaches based on magnetic resonance imaging (MRI) or X-ray computed tomography (CT) measure the effect of a contrast agent moving through blood vessels and into tissue. Contrast-agent free approaches, for example, based on intravoxel incoherent motion, also exist, but are not routinely used clinically. MR or CT perfusion imaging based on contrast agents relies on the estimation of the arterial input function (AIF) to approximately model tissue perfusion, neglecting spatial dependencies. Reliably estimating the AIF is also non-trivial, leading to difficulties with standardizing perfusion measures. In this work we propose a data-assimilation approach (PIANO) which estimates the velocity and diffusion fields of an advection-diffusion model best explaining the contrast dynamics. PIANO accounts for spatial dependencies and neither requires estimating the AIF nor relies on a particular contrast agent bolus shape. Specifically, we propose a convenient parameterization of the estimation problem, a numerical estimation approach, and extensively evaluate PIANO. We demonstrate that PIANO can successfully resolve velocity and diffusion field ambiguities and results in sensitive measures for the assessment of stroke, comparing favorably to conventional measures of perfusion.