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4D-Flow Cardiac Magnetic Resonance Imaging: An 8-Year Clinical Practice Review.

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Four-dimensional flow cardiac magnetic resonance (4D-flow CMR) offers accurate, reproducible blood flow assessment. This advanced imaging technique enhances diagnosis for congenital heart disease and valvular/aortic disorders.

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Area of Science:

  • Cardiovascular Imaging
  • Medical Physics
  • Hemodynamics

Background:

  • Conventional 2D phase-contrast techniques have limitations in accuracy and reproducibility.
  • Four-dimensional (4D) flow cardiac magnetic resonance (CMR) provides comprehensive assessment of blood flow in 4D.
  • 4D-flow CMR offers superior visual interpretation compared to 2D techniques.

Purpose of the Study:

  • To review the technical foundations, clinical applications, advantages, and limitations of 4D-flow CMR.
  • To synthesize clinical experience and published research on 4D-flow CMR.
  • To highlight the diagnostic performance of 4D-flow CMR in various cardiovascular conditions.

Main Methods:

  • Narrative review synthesizing clinical experience and published research.
  • Discussion of technical aspects: spatial/temporal resolution, velocity encoding, contrast, workflow, and post-processing.
  • Analysis of diagnostic performance influenced by technical parameters.

Main Results:

  • 4D-flow CMR accurately assesses cardiac shunts and quantifies pulmonary-to-systemic flow ratios in congenital heart disease (CHD).
  • It visualizes complex hemodynamic patterns and blood flow volumes.
  • Robust characterization of valvular and aortic disease through dynamic flow analysis and quantitative metrics.

Conclusions:

  • 4D-flow CMR is a powerful, noninvasive tool for enhancing clinical decision-making.
  • Growing evidence supports its routine use, especially for CHD and valvular/aortic disorders.
  • The technique provides accurate, reproducible, and visually interpretable blood flow data.