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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 ( PBF   L%  ) and using our proposed inflow-weighted pulmonary blood volume ( PBV   iw    L%  ). For  PBV   iw    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  PS   L%   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.

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