Go with the (4D) Flow!-Go with the (4D) Flow!

Video Transcription

Video Summary

The SCMR webinar “Go With the 4D Flow” explored how 4D flow MRI can provide whole-volume, time-resolved measurements of complex cardiovascular blood flow, complementing conventional imaging and allowing clinicians to investigate questions retrospectively.<br /><br />Three congenital heart disease cases illustrated its clinical value. In a Fontan patient with reassuring anatomy, 4D flow revealed synchronized flow reversals throughout the Fontan circuit. Combined with the ECG and other MRI findings, these patterns were linked to junctional rhythm and its effects on atrial contraction and pressure. In an infant with pulmonary atresia and complex surgical shunts, 4D flow quantified flow through the shunts and mitral regurgitation, helping clinicians assess systemic blood flow and avoid an unnecessary mitral valve intervention. In a patient with a double-orifice mitral valve, it characterized the valve anatomy and regurgitant jets, quantified regurgitation using multiple methods, and exposed a flow imbalance that led to recognition of an unsuspected partial anomalous pulmonary venous connection.<br /><br />Discussion emphasized 4D flow’s ability to assess multiple vessels in one acquisition, improve flow quantification, and reveal abnormalities that may not be apparent from anatomy alone. Experts discussed scan protocols for infants, velocity encoding, navigator use, post-processing, contrast options, and methods for quantifying valve regurgitation. They noted that contrast-enhanced imaging can improve signal, while useful studies are also possible without ferumoxytol. The webinar concluded with the announcement that SCMR had approved a 4D flow special interest group.

Keywords

4D flow MRI

cardiovascular blood flow

congenital heart disease

Fontan circulation

pulmonary atresia

mitral regurgitation

double-orifice mitral valve

flow quantification

partial anomalous pulmonary venous connection

SCMR webinar