Department of Radiology, University of California San Diego, 200 W Arbor Dr #8756, San Diego, CA 92103-8756.
Department of Radiology, Stanford University, Stanford, CA.
AJR Am J Roentgenol. 2021 Dec;217(6):1322-1332. doi: 10.2214/AJR.21.25978. Epub 2021 Jun 2.
MRI is an essential diagnostic tool in the anatomic and functional evaluation of cardiovascular disease. In many practices, 2D phase-contrast (2D-PC) MRI has been used for blood flow quantification. Four-dimensional flow MRI is a time-resolved volumetric acquisition that captures the vector field of blood flow along with anatomic images. It also provides a simpler acquisition compared with 2D-PC and facilitates a more accurate and comprehensive hemodynamic assessment. Advancements in accelerated imaging have significantly shortened scanning times for 4D flow MRI while preserving image quality, enabling this technology to transition from the research arena to routine clinical practice. In this article, we review technical optimization based on our more than 10 years of clinical experience with 4D flow MRI. We also present pearls and pitfalls in the practical application of 4D flow MRI, including how to quantify cardiovascular shunts, valvular or vascular stenosis, and valvular regurgitation. As experience increases, and as 4D flow sequences and postprocessing software become more broadly available, 4D flow MRI will likely become an essential component of cardiac imaging in practices involved in the management of congenital and acquired structural heart disease.
MRI 是心血管疾病解剖和功能评估的重要诊断工具。在许多临床实践中，二维相位对比（2D-PC）MRI 已被用于血流定量。四维血流 MRI 是一种时间分辨的容积采集方法，可捕获血流的向量场以及解剖图像。与 2D-PC 相比，它的采集过程更简单，并且可以更准确、全面地评估血流动力学。加速成像技术的进步显著缩短了四维血流 MRI 的扫描时间，同时保持了图像质量，使这项技术从研究领域过渡到常规临床实践。在本文中，我们将根据我们 10 多年的四维血流 MRI 临床经验，回顾技术优化。我们还介绍了四维血流 MRI 实际应用中的要点和陷阱，包括如何量化心血管分流、瓣膜或血管狭窄以及瓣膜反流。随着经验的增加，以及四维血流序列和后处理软件的广泛应用，四维血流 MRI 将可能成为先天性和获得性结构性心脏病管理相关临床实践中心脏成像的重要组成部分。
