The 39 steps: evading error and deciphering the secrets for accurate dynamic susceptibility contrast MRI.

Dynamic susceptibility contrast (DSC) MRI is the most commonly used MRI method to assess cerebral perfusion and other related haemodynamic parameters. Although the technique is well established and used routinely in clinical centres, there are still many problems that impede accurate perfusion quantification. In this review article, we present 39 steps which guide the reader through the theoretical principles, practical decisions, potential problems, current limitations and latest advances in DSC-MRI. The 39 steps span the collection, analysis and interpretation of DSC-MRI data, expounding issues and possibilities relating to the contrast agent, the acquisition of DSC-MRI data, data pre-processing, the contrast concentration-time course, the arterial input function, deconvolution, common perfusion parameters, post-processing possibilities, patient studies, absolute versus relative quantification and automated analysis methods.