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Eur Radiol. 2014 Jan;24(1):60-9. doi: 10.1007/s00330-013-2977-9. Epub 2013 Aug 23.

Fractal analysis in radiological and nuclear medicine perfusion imaging: a systematic review.

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Charité - Universitätsmedizin Berlin, Medical School, Department of Radiology, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany.



To provide an overview of recent research in fractal analysis of tissue perfusion imaging, using standard radiological and nuclear medicine imaging techniques including computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and to discuss implications for different fields of application.


A systematic review of fractal analysis for tissue perfusion imaging was performed by searching the databases MEDLINE (via PubMed), EMBASE (via Ovid) and ISI Web of Science.


Thirty-seven eligible studies were identified. Fractal analysis was performed on perfusion imaging of tumours, lung, myocardium, kidney, skeletal muscle and cerebral diseases. Clinically, different aspects of tumour perfusion and cerebral diseases were successfully evaluated including detection and classification. In physiological settings, it was shown that perfusion under different conditions and in various organs can be properly described using fractal analysis.


Fractal analysis is a suitable method for quantifying heterogeneity from radiological and nuclear medicine perfusion images under a variety of conditions and in different organs. Further research is required to exploit physiologically proven fractal behaviour in the clinical setting.


• Fractal analysis of perfusion images can be successfully performed. • Tumour, pulmonary, myocardial, renal, skeletal muscle and cerebral perfusion have already been examined. • Clinical applications of fractal analysis include tumour and brain perfusion assessment. • Fractal analysis is a suitable method for quantifying perfusion heterogeneity. • Fractal analysis requires further research concerning the development of clinical applications.

[Indexed for MEDLINE]

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