Perfusion

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A Lindbergh perfusion pump, c. 1935, an early device

for simulating natural perfusion
Perfusion is the passage of fluid through
the circulatory system or lymphatic
system to an organ or a tissue,[1] usually
referring to the delivery of blood to a
capillary bed in tissue. Perfusion is
measured as the rate at which blood is
delivered to tissue,[2] or volume of blood
per unit time (blood flow) per unit tissue
mass. The SI unit is m3/(s·kg), although
for human organs perfusion is typically
reported in ml/min/g.[3] The word is
derived from the French verb "perfuser"
meaning to "pour over or through".[4] All
animal tissues require an adequate blood
supply for health and life. Poor perfusion
(malperfusion), that is, ischemia, causes
health problems, as seen in cardiovascular
disease, including coronary artery disease,
cerebrovascular disease, peripheral artery
disease, and many other conditions.

Tests verifying that adequate perfusion

exists are a part of a patient's assessment
process that are performed by medical or
emergency personnel. The most common
methods include evaluating a body's skin
color, temperature, condition
(dry/soft/firm/swollen/sunken/etc), and
capillary refill.
During major surgery, especially
cardiothoracic surgery, perfusion must be
maintained and managed by the health
professionals involved, rather than left to
the body's homeostasis alone. As the lead
surgeons are often too busy to handle all
hemodynamic control by themselves,
specialists called perfusionists manage
this aspect. There are more than one
hundred thousand perfusion procedures
annually.[5]

Discovery
In 1920, August Krogh was awarded the
Nobel Prize in Physiology or Medicine for
his discovering the mechanism of
regulation of capillaries in skeletal
muscle.[6][7] Krogh was the first to describe
the adaptation of blood perfusion in
muscle and other organs according to
demands through the opening and closing
of arterioles and capillaries.

Malperfusion
Malperfusion can refer to any type of
incorrect perfusion though it usually refers
to hypoperfusion. The meaning of the
terms "overperfusion" and
"underperfusion" is relative to the average
level of perfusion that exists across all the
tissues in an individual body. Perfusion
levels also differ from person to person
depending on metabolic demand.

Examples follow:

Heart tissues are considered

overperfused because they normally are
receiving more blood than the rest of
tissues in the organism; they need this
blood because they are constantly
working.
In the case of skin cells, extra blood flow
in them is used for thermoregulation of
a body. In addition to delivering oxygen,
blood flow helps to dissipate heat in a
 physical body by redirecting warm blood
closer to its surface where it can help to
cool a body through sweating and
thermal dissipation.
Many types of tumors, and especially
certain types, have been described as
"hot and bloody" because of their
overperfusion relative to the body
overall.

Overperfuson and underperfusion should

not be confused with hypoperfusion and
hyperperfusion, which relate to the
perfusion level relative to a tissue's current
need to meet its metabolic needs. For
example, hypoperfusion can be caused
when an artery or arteriole that supplies
blood to a volume of tissue becomes
blocked by an embolus, causing either no
blood or at least not enough blood to
reach the tissue. Hyperperfusion can be
caused by inflammation, producing
hyperemia of a body part. Malperfusion,
also called poor perfusion, is any type of
incorrect perfusion. There is no official or
formal dividing line between
hypoperfusion and ischemia; sometimes
the latter term refers to zero perfusion, but
often it refers to any hypoperfusion that is
bad enough to cause necrosis.

Measurement
In equations, the symbol Q is sometimes
used to represent perfusion when referring
to cardiac output. However, this
terminology can be a source of confusion
since both cardiac output and the symbol
Q refer to flow (volume per unit time, for
example, L/min), whereas perfusion is
measured as flow per unit tissue mass
(mL/(min·g)).

Microspheres

Microspheres that are labeled with

radioactive isotopes have been widely
used since the 1960s. Radioactively
labeled particles are injected into the test
subject and a radiation detector measures
radioactivity in tissues of interest.[8]
Application of this process is used to
develop radionuclide angiography, a
method of diagnosing heart problems.

In the 1990s, methods for using

fluorescent microspheres became a
common substitute for radioactive
particles.[9]

Nuclear medicine

Perfusion of various tissues can be readily

measured in vivo with nuclear medicine
methods which are mainly positron
emission tomography (PET) and single
photon emission computed tomography
(SPECT). Various radiopharmaceuticals
targeted at specific organs are also
available, some of the most common are

99mTc labelled HMPAO and ECD for

brain perfusion (rCBF) studied with
SPECT
99mTc labelled Tetrofosmin and
Sestamibi for myocardial perfusion
imaging with SPECT
133Xe-gas for absolute quantification of
brain perfusion (rCBF) with SPECT
15O-labeled water for brain perfusion
(rCBF) with PET (absolute quantification
 is possible when measuring arterial
radioactivity concentration)
82Rb-chloride for measuring myocardial
perfusion with PET (absolute
quantification is possible)

MRI

Two main categories of magnetic

resonance imaging (MRI) techniques can
be used to measure tissue perfusion in
vivo.

The first is based on the use of an

injected contrast agent that changes the
magnetic susceptibility of blood and
thereby the MR signal which is
 repeatedly measured during bolus
passage.[10]
The other category is based on arterial
spin labelling (ASL), where arterial blood
is magnetically tagged before it enters
into the tissue being examined and the
amount of labelling that is measured
and compared to a control recording
obtained without spin labelling.[11]

CT

Brain perfusion (more correctly transit

times) can be estimated with contrast-
enhanced computed tomography.[12]
Thermal diffusion

Perfusion can be determined by

measuring the total thermal diffusion and
then separating it into thermal conductivity
and perfusion components.[13] rCBF is
usually measured continuously in time. It
is necessary to stop the measurement
periodically to cool down and reassess the
thermal conductivity.

See also
Reperfusion injury
Machine perfusion
Perfusionist
 Myocardial perfusion imaging
rCBF
Cerebral edema

References
1. American Psychological Association
(APA): perfusion. (n.d.).
Dictionary.com Unabridged (v 1.1).
Retrieved March 20, 2008, from
Dictionary.com website:
http://dictionary.reference.com/brow
se/perfusion
2. Thomas DL, Lythgoe MF, Pell GS,
Calamante F, Ordidge RJ (2000). "The
measurement of diffusion and
perfusion in biological systems using
magnetic resonance imaging". Phys
Med Biol. 45 (8): R97–138.
doi:10.1088/0031-9155/45/8/201 .
PMID 10958179 .
3. Engblom H, Xue H, Akil S, Carlsson M,
Hindorf C, Oddstig J, Hedeer F,
Hansen MS, Aletras AH, Kellman P,
Arheden H (2017). "Fully quantitative
cardiovascular magnetic resonance
myocardial perfusion ready for
clinical use: a comparison between
cardiovascular magnetic resonance
imaging and positron emission
tomography" . J Cardiovasc Magn
Reson. 19 (1): 78.
doi:10.1186/s12968-017-0388-9 .
PMC 5648469 . PMID 29047385 .
4. "Perfusion > What is Perfusion?" .
Cardiovascular Perfusion Forum.
5. "Perfusion > Perfusion Services" .
Specialty Care Services Group.
6. Larsen, E. H. (2007). "August Krogh
(1874–1949): 1920 Nobel Prize".
Ugeskrift for laeger. 169 (35): 2878.
PMID 17877986 .
7. Sulek, K. (1967). "Nobel prize for
August Krogh in 1920 for his
discovery of regulative mechanism in
the capillaries". Wiadomosci
lekarskie (Warsaw, Poland : 1960). 20
(19): 1829. PMID 4870667 .
 8. Studies of the Circulation with
Radioactive Microspheres., Wagner et
al, Invest. Radiol., 1969. 4(6): p. 374-
386.
9. "Fluorescent Microspheres" (PDF).
Fluorescent Microsphere Resource
Center. Archived from the original
(PDF) on 2012-10-02.
10. Huettel, S. A.; Song, A. W.; McCarthy,
G. (2009), Functional Magnetic
Resonance Imaging (2 ed.),
Massachusetts: Sinauer, ISBN 978-0-
87893-286-3
11. Detre, John A.; Rao, Hengyi; Wang,
Danny J. J.; Chen, Yu Fen; Wang, Ze
(2012-05-01). "Applications of arterial
spin labeled MRI in the brain" .
Journal of magnetic resonance
imaging: JMRI. 35 (5): 1026–1037.
doi:10.1002/jmri.23581 . ISSN 1522-
2586 . PMC 3326188 .
PMID 22246782 .
12. L. Axel. Cerebral blood flow
determination by rapid-sequence
computed-tomography: theoretical
analysis. Radiology 137: 679–686,
December 1980
13. Vajkoczy P, Roth H, Horn P, et al.
(August 2000). "Continuous
monitoring of regional cerebral blood
flow: experimental and clinical
validation of a novel thermal diffusion
microprobe". Journal of
Neurosurgery. 93 (2): 265–74.
doi:10.3171/jns.2000.93.2.0265 .
PMID 10930012 .

External links
Perfusion.com - Perfusionist Website
Sanibel Symposium Perfusion
Conference
Perfusion Services
 Perfusion Protocol
University of Iowa Perfusion Technology
Program
SUNY Upstate Medical University
Perfusion Program
Cardiac Surgery Portal
The New Orleans Conference: Practices
in Cardiac Surgery and Extracorporeal
Technologies

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Last edited 23 days ago by OAbot

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