4D flow cardiovascular magnetic resonance consensus statement

Petter Dyverfeldt*, Malenka Bissell, Alex J. Barker, Ann F. Bolger, Carl Johan Carlhäll, Tino Ebbers, Christopher J. Francios, Alex Frydrychowicz, Julia Geiger, Daniel Giese, Michael D. Hope, Philip J. Kilner, Sebastian Kozerke, Saul Myerson, Stefan Neubauer, Oliver Wieben, Michael Markl

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

630 Scopus citations


Abstract Pulsatile blood flow through the cavities of the heart and great vessels is time-varying and multidirectional. Access to all regions, phases and directions of cardiovascular flows has formerly been limited. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has enabled more comprehensive access to such flows, with typical spatial resolution of 1.5×1.5×1.5 - 3×3×3 mm3, typical temporal resolution of 30-40 ms, and acquisition times in the order of 5 to 25 min. This consensus paper is the work of physicists, physicians and biomedical engineers, active in the development and implementation of 4D Flow CMR, who have repeatedly met to share experience and ideas. The paper aims to assist understanding of acquisition and analysis methods, and their potential clinical applications with a focus on the heart and greater vessels. We describe that 4D Flow CMR can be clinically advantageous because placement of a single acquisition volume is straightforward and enables flow through any plane across it to be calculated retrospectively and with good accuracy. We also specify research and development goals that have yet to be satisfactorily achieved. Derived flow parameters, generally needing further development or validation for clinical use, include measurements of wall shear stress, pressure difference, turbulent kinetic energy, and intracardiac flow components. The dependence of measurement accuracy on acquisition parameters is considered, as are the uses of different visualization strategies for appropriate representation of time-varying multidirectional flow fields. Finally, we offer suggestions for more consistent, user-friendly implementation of 4D Flow CMR acquisition and data handling with a view to multicenter studies and more widespread adoption of the approach in routine clinical investigations.

Original languageEnglish (US)
Article number174
JournalJournal of Cardiovascular Magnetic Resonance
Issue number1
StatePublished - Aug 10 2015


  • 4D Flow CMR
  • 4D Flow MRI
  • Cardiovascular
  • Clinical
  • Flow quantification
  • Flow visualization
  • Hemodynamics
  • MR flow imaging
  • Phase-contrast magnetic resonance imaging
  • Recommendations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Family Practice
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging


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