Comparison of bulk flow measurements in the large vessels between four-dimensional flow (4D-flow) and two-dimensional phase contrast (2D-PC) magnetic resonance imaging (MRI)
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Updated: Mar 3, 2026
In vitro Assessment of Aortic Regurgitation Using Four-Dimensional Flow Magnetic Resonance Imaging
Published on: February 25, 2022
1Imaging and Phenotyping Laboratory, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia; Sydney Medical School & School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia.
Aim:
The clinical integration of four-dimensional flow magnetic resonance imaging (4D-flow MRI) for cardiovascular assessment remains a challenge due to the expertise and resources required for analysis, and there is no large-scale systematic validation of the technique. We aim to evaluate the bulk flow measurements in the large vessels using 4D-flow MRI compared with conventional cardiac MRI in a large cohort as part of the prospective 4DCarE study.
Materials And Methods:
We conducted a large cohort prospective study to compare the bulk flow measurements in the ascending aorta and main pulmonary artery using 4D-flow and 2D phase contrast (2D-PC) MRI and analysed the 4D-flow measurements using two different commercially available software packages.
Results:
A total of 500 participants with a normal or pathological cardiac history were evaluated. Within the limitations of technical differences, 4D-flow demonstrated clinically consistent and reliable measurements compared with 2D-PC, although 4D-flow measurements showed a systematic bias towards undermeasurement compared with 2D-PC, irrespective of software used. Both 4D-flow and 2D-PC demonstrated good internal consistency for normal and pathological cases. The incorporation of artificial intelligence in the image annotation process showed early promises in reducing time and labour intensity and potentially improving the clinical integration of 4D-flow MRI, however, the technology remains nascent, and further development and validation are required.
Conclusion:
Bulk flow measurements in the large vessels were grossly clinically consistent between 4D-flow and 2D-PC in this large cohort study, although 4D-flow showed systematic undermeasurement compared with 2D-PC.
