4-D flow magnetic resonance imaging: blood flow quantification compared to 2-D phase-contrast magnetic resonance imaging and Doppler echocardiography

Maya Gabbour, Susanne Schnell, Kelly Jarvis, Joshua D. Robinson, Michael Markl, Cynthia K. Rigsby*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Background: Doppler echocardiography (echo) is the reference standard for blood flow velocity analysis, and two-dimensional (2-D) phase-contrast magnetic resonance imaging (MRI) is considered the reference standard for quantitative blood flow assessment. However, both clinical standard-of-care techniques are limited by 2-D acquisitions and single-direction velocity encoding and may make them inadequate to assess the complex three-dimensional hemodynamics seen in congenital heart disease. Four-dimensional flow MRI (4-D flow) enables qualitative and quantitative analysis of complex blood flow in the heart and great arteries. Objectives: The objectives of this study are to compare 4-D flow with 2-D phase-contrast MRI for quantification of aortic and pulmonary flow and to evaluate the advantage of 4-D flow-based volumetric flow analysis compared to 2-D phase-contrast MRI and echo for peak velocity assessment in children and young adults. Materials and methods: Two-dimensional phase-contrast MRI of the aortic root, main pulmonary artery (MPA), and right and left pulmonary arteries (RPA, LPA) and 4-D flow with volumetric coverage of the aorta and pulmonary arteries were performed in 50 patients (mean age: 13.1 ± 6.4 years). Four-dimensional flow analyses included calculation of net flow and regurgitant fraction with 4-D flow analysis planes similarly positioned to 2-D planes. In addition, 4-D flow volumetric assessment of aortic root/ascending aorta and MPA peak velocities was performed and compared to 2-D phase-contrast MRI and echo. Results: Excellent correlation and agreement were found between 2-D phase-contrast MRI and 4-D flow for net flow (r = 0.97, P < 0.001) and excellent correlation with good agreement was found for regurgitant fraction (r = 0.88, P < 0.001) in all vessels. Two-dimensional phase-contrast MRI significantly underestimated aortic (P = 0.032) and MPA (P < 0.001) peak velocities compared to echo, while volumetric 4-D flow analysis resulted in higher (aortic: P = 0.001) or similar (MPA: P = 0.98) peak velocities relative to echo. Conclusion: Excellent flow parameter agreement between 2-D phase-contrast MRI and 4-D flow and the improved volumetric 4-D flow velocity analysis relative to echo suggests that 4-D flow has the potential to become a clinical alternative to 2-D phase-contrast MRI.

Original languageEnglish (US)
Pages (from-to)804-813
Number of pages10
JournalPediatric radiology
Issue number6
StatePublished - Jun 1 2015


  • 4-D flow
  • Cardiovascular magnetic resonance
  • Congenital heart disease
  • Magnetic resonance imaging
  • Pediatric
  • Phase-contrast

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Pediatrics, Perinatology, and Child Health


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