Digital perfusion phantoms for visual perfusion validation.

OBJECTIVE Despite the increasingly broad use of perfusion applications, we still have no generally accessible means for their verification: The common sense of perfusion maps and "bona fides" of perfusion software vendors remain the only grounds for acceptance. Thus, perfusion applications are one of a very few clinical tools considerably lacking practical objective hands-on validation. MATERIALS AND METHODS To solve this problem, we introduce digital perfusion phantoms (DPPs)--numerically simulated DICOM image sequences specifically designed to have known perfusion maps with simple visual patterns. Processing DPP perfusion sequences with any perfusion algorithm or software of choice and comparing the results with the expected DPP patterns provide a robust and straightforward way to control the quality of perfusion analysis, software, and protocols. RESULTS The deviations from the expected DPP maps, observed in each perfusion software, provided clear visualization of processing differences and possible perfusion implementation errors. CONCLUSION Perfusion implementation errors, often hidden behind real-data anatomy and noise, become very visible with DPPs. We strongly recommend using DPPs to verify the quality of perfusion applications.