Clinical applications of intra-cardiac four-dimensional flow cardiovascular magnetic resonance: A systematic review

Saul Crandon, Mohammed Elbaz, Jos J.M. Westenberg, Rob J. van der Geest, Sven Plein*, Pankaj Garg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background Four-dimensional flow cardiovascular magnetic resonance (4D flow CMR) is an emerging non-invasive imaging technology used to visualise and quantify intra-cardiac blood flow. The aim of this systematic review is to assess the literature on the current clinical applications of intra-cardiac 4D flow CMR. Methods A systematic review was conducted to evaluate the literature on the intra-cardiac clinical applications of 4D flow CMR. Structured searches were carried out on Medline, EMBASE and the Cochrane Library in October 2016. A modified Critical Skills Appraisal Programme (CASP) tool was used to objectively assess and score the included studies. Studies were categorised as ‘highly clinically applicable’ for scores of 67–100%, ‘potentially clinically applicable’ for 34–66% and ‘less clinically applicable’ for 0–33%. Results Of the 1608 articles screened, 44 studies met eligibility for systematic review. The included literature consisted of 22 (50%) mechanistic studies, 18 (40.9%) pilot studies and 4 (9.1%) diagnostic studies. Based on the modified CASP tool, 27 (62%) studies were ‘highly clinically applicable’, 9 (20%) were ‘potentially clinically applicable’ and 8 (18%) were ‘less clinically applicable’. Conclusions There are many proposed methods for using 4D flow CMR to quantify intra-cardiac flow. The evidence base is mainly mechanistic, featuring single-centred designs. Larger, multi-centre studies are required to validate the proposed techniques and investigate the clinical advantages that 4D flow CMR offers over standard practices. PROSPERO = CRD42016051438.

Original languageEnglish (US)
Pages (from-to)486-493
Number of pages8
JournalInternational Journal of Cardiology
StatePublished - Dec 15 2017


  • 4D flow CMR
  • 4D flow MRI
  • Cardiovascular magnetic resonance
  • Four-dimensional
  • Intra-cardiac
  • Systematic review

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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