4.5 Review

4D Flow cardiovascular magnetic resonance consensus statement: 2023 update

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Article Radiology, Nuclear Medicine & Medical Imaging

Comprehensive Neonatal Cardiac, Feed and Wrap, Non-contrast, Non-sedated, Free-breathing Compressed Sensing 4D Flow MRI Assessment

Hannah R. Panayiotou et al.

Summary: This study tested the feasibility of compressed sensing (CS) 4D flow MRI in the neonatal population and compared it with standard two-dimensional phase-contrast (PC) flow MRI. The results showed that CS 4D flow MRI quantification is similar to 2D PC free-breathing imaging with excellent interobserver and intraobserver agreement.

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Article Radiology, Nuclear Medicine & Medical Imaging

Comparison of 2D and 4D Flow MRI in Neonates Without General Anesthesia

Pia Sjoberg et al.

Summary: The study aimed to validate the accuracy and precision of 2D and 4D flow magnetic resonance imaging (MRI) in a phantom and neonates, and compare the scan time of the two methods. The results showed that neonatal 4D flow MRI has good accuracy and internal consistency, and can be acquired with a shorter scan time compared to 2D flow MRI.

JOURNAL OF MAGNETIC RESONANCE IMAGING (2023)

Article Cardiac & Cardiovascular Systems

Repeatability and reproducibility of various 4D Flow MRI postprocessing software programs in a multi-software and multi-vendor cross-over comparison study

Thekla H. Oechtering et al.

Summary: This study compared the results of healthy subjects examined on two different cardiovascular magnetic resonance scanners using different software programs. The results showed that only SW-A and SW-C software can be used equivalently for measuring cardiac parameters. Additionally, the study found that there is high intra- and interreader variability for all parameters in clinical practice.

JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE (2023)

Article Radiology, Nuclear Medicine & Medical Imaging

Segmentation of the Aorta and Pulmonary Arteries Based on 4D Flow MRI in the Pediatric Setting Using Fully Automated Multi-Site, Multi-Vendor, and Multi-Label Dense U-Net

Takashi Fujiwara et al.

Summary: This study aimed to investigate multi-site CNN segmentation of 4D flow MRI for pediatric blood flow measurement. The results showed that multi-site CNN-based segmentation and blood flow measurement are feasible and perform similarly to single-site CNNs.

JOURNAL OF MAGNETIC RESONANCE IMAGING (2022)

Article Radiology, Nuclear Medicine & Medical Imaging

Echo planar imaging-induced errors in intracardiac 4D flow MRI quantification

Jos J. M. Westenberg et al.

Summary: Velocity and flow rates are inaccurate for 4DEPI with EPI factor 5 when flow is parallel to the readout or blip phase-encoding gradient. However, mean differences in flow rate, voxel-based speed, and spatio-temporal median speed were acceptable (<= 10%) when comparing 4DEPI to 4DGRE for intracardiac flow in healthy volunteers.

MAGNETIC RESONANCE IN MEDICINE (2022)

Article Radiology, Nuclear Medicine & Medical Imaging

Pilot tone navigation for respiratory and cardiac motion-resolved free-running 5D flow MRI

Mariana B. L. Falcao et al.

Summary: In this study, the pilot tone (PT) navigation system was successfully integrated into a reconstruction framework for respiratory and cardiac motion-resolved 5D flow MRI, showing equivalent results to the previously established self-gating (SG) technique. The quality of PT remained constant and independent from changes to the acquisition parameters.

MAGNETIC RESONANCE IN MEDICINE (2022)

Article Radiology, Nuclear Medicine & Medical Imaging

Abdominal applications of quantitative 4D flow MRI

Thekla H. Oechtering et al.

Summary: 4D flow MRI is a quantitative MRI technique that allows comprehensive assessment of time-resolved hemodynamics and vascular anatomy. Despite challenges in abdominal applications, such as complex vascular structures, it has shown promising diagnostic and prognostic potential.

ABDOMINAL RADIOLOGY (2022)

Article Radiology, Nuclear Medicine & Medical Imaging

Traveling Volunteers: A Multi-Vendor, Multi-Center Study on Reproducibility and Comparability of 4D Flow Derived Aortic Hemodynamics in Cardiovascular Magnetic Resonance

Aylin Demir et al.

Summary: The study investigated the inter-vendor comparability of aortic hemodynamic parameters derived from 4D Flow MR, as well as assessed the repeatability of scan-rescan and intra- and interobserver reproducibility. Results showed significant differences between scanners of different vendors, but good reproducibility and consistency within and between observers.

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Review Radiology, Nuclear Medicine & Medical Imaging

Four-Dimensional Flow Magnetic Resonance Imaging in the Assessment of Blood Flow in the Heart and Great Vessels: A Systematic Review

Ciara M. Doyle et al.

Summary: This review analyzes the comparability of 4D flow MRI to 2D flow MRI, Doppler echocardiography, and invasive catheterization. Results show that 4D flow MRI agrees with reference standards in the measurement of peak velocity and stroke volume in 55% of cases. Valve tracking significantly improves agreement between 4D flow MRI and reference methods, with 79% matching when valve tracking is used compared to 50% without (P = 0.04).

JOURNAL OF MAGNETIC RESONANCE IMAGING (2022)

Article Radiology, Nuclear Medicine & Medical Imaging

Deep learning-based velocity antialiasing of 4D-flow MRI

Haben Berhane et al.

Summary: The purpose of this study was to develop a convolutional neural network (CNN) for the correction of velocity aliasing in 4D-flow MRI. The CNN showed excellent performance in both simulated and existing data sets, outperforming conventional algorithms in terms of accuracy and detection rate. The results demonstrated that deep learning enabled fast and robust anti-aliasing in 4D-flow MRI.

MAGNETIC RESONANCE IN MEDICINE (2022)

Article Cardiac & Cardiovascular Systems

Aortic flow dynamics and stiffness in Loeys-Dietz syndrome patients: a comparison with healthy volunteers and Marfan syndrome patients

Aroa Ruiz-Munoz et al.

Summary: Aortic stiffness is higher in Loeys-Dietz syndrome (LDS) patients, with reduced rotational flow and abnormal wall shear stress compared to healthy volunteers (HV). However, LDS patients showed similar aortic stiffness and overlapping aortic flow features when compared to Marfan syndrome (MFS) patients.

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Article Multidisciplinary Sciences

Synthesis of patient-specific multipoint 4D flow MRI data of turbulent aortic flow downstream of stenotic valves

Pietro Dirix et al.

Summary: This study proposes a method to synthesize patient-specific 4D flow MRI datasets of turbulent flow paired with ground truth flow data for training of inference methods. The results demonstrate the importance of paired ground truth and 4D flow MRI data for accurately assessing turbulent flow inference using 4D flow MRI exams.

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Clinical Applications of 4D Flow MR Imaging in Aortic Valvular and Congenital Heart Disease

Noriko Oyama-Manabe et al.

Summary: 4D flow MRI is a method for visualizing and quantifying aortic and intracardiac flow. It allows for comprehensive assessment of different vessels and is particularly beneficial for patients with complicated congenital heart disease.

MAGNETIC RESONANCE IN MEDICAL SCIENCES (2022)

Review Radiology, Nuclear Medicine & Medical Imaging

Utility of 4D Flow MRI in Thoracic Aortic Diseases: A Literature Review of Clinical Applications and Current Evidence

Kenichiro Takahashi et al.

Summary: Despite technical advancements, surgery on the thoracic aorta remains challenging with high mortality and morbidity rates. Understanding the complex hemodynamic environment inside the aorta will facilitate personalized risk assessments. 4D flow MRI has shown significant advances in evaluating flow dynamics for thoracic aortic diseases.

MAGNETIC RESONANCE IN MEDICAL SCIENCES (2022)

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4D flow MRI applications in congenital heart disease

Judy Rizk

Summary: Advances in the diagnosis and management of congenital heart disease have led to more patients surviving into adulthood and requiring lifelong follow-up. 3D velocity encoding allows for flow quantification, visualization of multidirectional flow patterns, and study of advanced hemodynamic parameters. 4D flow MRI has provided insights into abnormal hemodynamics in congenital heart disease, particularly in conditions such as bicuspid aortic valve disease and Fontan circulation.

EUROPEAN RADIOLOGY (2021)

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Phase unwrapping with a rapid opensource minimum spanning tree algorithm (ROMEO)

Barbara Dymerska et al.

Summary: ROMEO is a rapid and accurate MRI phase-unwrapping technique that outperforms traditional methods in challenging phase topographies, providing more reliable results with faster processing times.

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Using 5D flow MRI to decode the effects of rhythm on left atrial 3D flow dynamics in patients with atrial fibrillation

Liliana Ma et al.

Summary: This study used a 5D flow framework to explore the influence of arrhythmia on thrombogenic hemodynamic parameters in patients with atrial fibrillation (AF). The results showed that AF burden was significantly correlated with 5D flow-derived peak (PV) and mean (MV) velocity, providing a novel approach to investigate arrhythmias and their effects on hemodynamics.

MAGNETIC RESONANCE IN MEDICINE (2021)

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Additional value and new insights by four-dimensional flow magnetic resonance imaging in congenital heart disease: application in neonates and young children

Julia Geiger et al.

Summary: Cardiovascular MRI has become essential in imaging congenital heart disease in children, providing crucial information on anatomy, blood flow, and function. Four-dimensional flow MRI is emerging as a new technique for visualization and assessment of blood flow in infants, offering new insights in disease understanding and therapy planning.

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Divergence-Free Constrained Phase Unwrapping and Denoising for 4D Flow MRI Using Weighted Least-Squares

Jiacheng Zhang et al.

Summary: The novel divergence-free constrained phase unwrapping method proposed in this study shows promising reliability and robustness for phase unwrapping in 4D flow MRI, leading to improved accuracy of velocity and hemodynamic quantities. The method demonstrated enhanced performance compared to the state-of-the-art single-step Laplacian algorithm, especially in cases with low venc ratios.

IEEE TRANSACTIONS ON MEDICAL IMAGING (2021)

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Standard and emerging CMR methods for mitral regurgitation quantification

Benjamin Fidock et al.

Summary: This study compared the agreement and reproducibility of different CMR methods for quantifying mitral regurgitation across different etiologies. The results showed that methods were comparable in secondary MR and MVR cases, but not in primary MR. The MRMVAV method demonstrated the highest reproducibility and consistency across all types of MR.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2021)

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Retrospective Camera-Based Respiratory Gating in Clinical Whole-Heart 4D Flow MRI

Lukas M. Gottwald et al.

Summary: A comparison was made between camera-based respiratory gating and conventional liver-lung navigator-based gating, as well as no gating, in whole-heart 4D flow MRI. The results showed that both camera-based and navigator-based gating were superior in image quality compared to no gating, with some differences in quantitative flow analysis.

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4D flow MRI: impact of region of interest size, angulation and spatial resolution on aortic flow assessment

M. E. Casciaro et al.

Summary: The study aimed to quantify the influence of ROI sizing, angulation, and spatial resolution on blood flow measurements using 4D flow. Results showed that patients had a larger ascending aorta than healthy volunteers, but net blood flow volumes were similar between patients and controls. The ascending aorta was the most sensitive to changes in ROI, with variations in diameter and tilt angle affecting flow volumes significantly.

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Multicenter Consistency Assessment of Valvular Flow Quantification With Automated Valve Tracking in 4D Flow CMR

Joe F. Juffermans et al.

Summary: The study showed that consistent valvular flow quantification can be achieved using automated retrospective valve tracking in 4D flow CMR, with strong interobserver agreement and low intervalvular variation.

JACC-CARDIOVASCULAR IMAGING (2021)

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Assessment of ventricular flow dynamics by 4D-flow MRI in patients following surgical repair of d-transposition of the great arteries

Fraser M. Callaghan et al.

Summary: 4D-flow MRI pathline tracking reveals disordered ventricular flow patterns and associated energy loss in d-TGA patients.

EUROPEAN RADIOLOGY (2021)

Article Cardiac & Cardiovascular Systems

Abnormal torsion and helical flow patterns of the neo-aorta in hypoplastic left heart syndrome assessed with 4D-flow MRI

Dominik Daniel Gabbert et al.

Summary: The Norwood procedure is the first stage of correction for patients with hypoplastic left heart syndrome (HLHS) and may lead to an abnormal neoaortic anatomy. This study found that the abnormal twist of the neoaortic arch in HLHS patients is associated with abnormal helical flow patterns, potentially leading to increased RV afterload and myocardial hypertrophy. Insights from 4D-flow MRI may guide further improvements in surgical aortic reconstruction for better neoaortic fluid dynamics in HLHS patients.

CARDIOVASCULAR DIAGNOSIS AND THERAPY (2021)

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Numerical simulation of time-resolved 3D phase-contrast magnetic resonance imaging

Thomas Puiseux et al.

Summary: A numerical approach for simulating time-resolved 3D phase-contrast MRI under realistic flow conditions is presented. The Navier-Stokes and Bloch equations are solved with specific strategies to reduce computational cost. The simulated results compare favorably with experimental data.

PLOS ONE (2021)

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Hemodynamic Profiles Before and After Surgery in Bicuspid Aortic Valve Disease-A Systematic Review of the Literature

Daniel G. W. Cave et al.

Summary: 4D flow MRI provides new tools for the assessment and prediction of pathological aortic dilatation in patients with bicuspid aortic valve (BAV) disease, and can help tailor interventions based on flow patterns seen post-bioprosthetic valve implantation. Additionally, it has the potential to support the development of artificial valve prostheses and aortic conduits with more physiological flow patterns.

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Hemodynamic Assessment of Structural Heart Disease Using 4D Flow MRI: How We Do It

Kathleen Jacobs et al.

Summary: MRI is essential in evaluating cardiovascular disease, with 4D flow MRI offering a more convenient and comprehensive hemodynamic assessment compared to 2D phase-contrast MRI. Advances in accelerated imaging have shortened scanning times while maintaining image quality, transitioning 4D flow MRI from research to clinical practice. With increasing experience and availability of technology, 4D flow MRI is likely to become a crucial component in cardiac imaging.

AMERICAN JOURNAL OF ROENTGENOLOGY (2021)

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The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives

Baiyan Zhuang et al.

Summary: 4D flow MRI utilizes blood flow encoding in three directions to comprehensively and accurately quantify and visualize hemodynamic parameters. It is widely used in various parts of the body and plays a crucial role in modern clinical practice.

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Prevalence of Venovenous Shunting and High-Output State Quantified with 4D Flow MRI in Patients with Fontan Circulation

Francesca Raimondi et al.

Summary: Four-dimensional flow MRI can reliably quantify Fontan flow and venovenous shunting, with a higher proportion of patients than expected exhibiting high-output states with common venovenous collaterals.

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Quantification of regurgitation in mitral valve prolapse with four-dimensional flow cardiovascular magnetic resonance

Ricardo A. Spampinato et al.

Summary: This study evaluated the clinical utility of cine-guided valve segmentation in 4D flow CMR for assessing MR in MVP compared to standardized routine CMR and transthoracic echocardiography. The results showed that cine-guided valve segmentation in 4D flow CMR is feasible and comparable to standard CMR, but with lower regurgitant volume when TTE is used as a reference. In addition, 4DF(indirect) quantification showed higher intra- and inter-technique agreement than 4DF(direct) quantification, suggesting it could be used as an adjunctive technique for cross-checking MR quantification in MVP.

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Four-dimensional flow cardiovascular magnetic resonance in tetralogy of Fallot: a systematic review

Ayah Elsayed et al.

Summary: 4D flow CMR shows potential in assessing rTOF, particularly in retrospective valve tracking for flow evaluation, velocity profiling, intra-cardiac kinetic energy quantification, and vortex visualization. Protocols should be targeted to pathology. Prospective, randomized, multi-centered studies are required to validate these new characteristics and establish their clinical use.

JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE (2021)

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Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation

Marco Spartera et al.

Summary: This study systematically investigated the reproducibility and temporal stability of left atrial 4D flow in atrial fibrillation and sinus rhythm subjects. The results showed that peak velocity and vorticity are the most reproducible and temporally stable novel biomarkers, robust to changes in heart rate, blood pressure, and differences in heart rhythm.

JOURNAL OF CARDIOVASCULAR MAGNETIC RESONANCE (2021)

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Reproducibility of Aorta Segmentation on 4D Flow MRI in Healthy Volunteers

Joe F. Juffermans et al.

Summary: This study assessed the interexamination, interobserver reproducibility, and intraobserver repeatability of aortic lumen segmentation on 4D flow MRI. The results showed comparable reproducibility and repeatability for each parameter. Excellent reproducibility and repeatability were observed for maximal diameter, while good reproducibility and repeatability were found for curvature radius.

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Highly accelerated aortic 4D flow MRI using compressed sensing: Performance at different acceleration factors in patients with aortic disease

Ashitha Pathrose et al.

Summary: The study systematically assessed the feasibility and performance of a highly accelerated compressed sensing (CS) 4D flow MRI framework at three different acceleration factors for quantifying aortic flow dynamics and wall shear stress in patients with aortic disease. Results showed that while the highly accelerated CS 4D flow had advantages in scan time, it systematically underestimated various hemodynamic parameters during measurements.

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M. A. Isorni et al.

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Three-dimensional and four-dimensional flow assessment in congenital heart disease

Evangeline Warmerdam et al.

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