van Schuppen Joost, van der Hulst Annelies E, den Harder J Michiel, Gottwald Lukas M, van Luijk Raschel D, van den Noort Josien C, Nelissen Jules L, Coerkamp Casper F, Boekholdt S Matthijs, Groot Paul F C, Nederveen Aart, van Ooij Pim, Planken R Nils
Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, The Netherlands.
Atherosclerosis & Ischemic Syndromes, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
J Magn Reson Imaging. 2025 Apr;61(4):1618-1628. doi: 10.1002/jmri.29550. Epub 2024 Aug 21.
Whole-heart 4D-flow MRI is a valuable tool for advanced visualization and quantification of blood flow in cardiovascular imaging. Despite advantages over 2D-phase-contrast flow, clinical implementation remains only partially exploited due to many hurdles in all steps, from image acquisition, reconstruction, postprocessing and analysis, clinical embedment, reporting, legislation, and regulation to data storage. The intent of this manuscript was 1) to evaluate the extent of clinical implementation of whole-heart 4D-flow MRI, 2) to identify hurdles hampering clinical implementation, and 3) to reach consensus on requirements for clinical implementation of whole-heart 4D-flow MRI. This study is based on Delphi analysis. This study involves a panel of 18 experts in the field on whole-heart 4D-flow MRI. The experience with and opinions of experts (mean 13 years of experience, interquartile range 6) in the field were aggregated. This study showed that among experts in the cardiovascular field, whole-heart 4D-flow MRI is currently used for both clinical and research purposes. Overall, the panelists agreed that major hurdles currently hamper implementation and utilization. The sequence-specific hurdles identified were long scan time and lack of standardization. Further hurdles included cumbersome and time-consuming segmentation and postprocessing. The study concludes that implementation of whole-heart 4D-flow MRI in clinical routine is feasible, but the implementation process is complex and requires a dedicated, multidisciplinary team. A predefined plan, including risk assessment and technique validation, is essential. The reported consensus statements may guide further tool development and facilitate broader implementation and clinical use. LEVEL OF EVIDENCE: NA TECHNICAL EFFICACY: Stage 5.
全心4D流磁共振成像（MRI）是心血管成像中用于血流高级可视化和定量分析的宝贵工具。尽管相较于二维相位对比血流成像具有优势，但由于从图像采集、重建、后处理与分析、临床嵌入、报告、立法监管到数据存储等各个环节存在诸多障碍，其临床应用仍仅得到部分开发。本手稿的目的是：1）评估全心4D流MRI的临床应用程度；2）识别阻碍临床应用的障碍；3）就全心4D流MRI临床应用的要求达成共识。本研究基于德尔菲分析。该研究涉及一个由18位全心4D流MRI领域专家组成的小组。汇总了该领域专家的经验和意见（平均经验13年，四分位间距6年）。该研究表明，在心血管领域专家中，全心4D流MRI目前用于临床和研究目的。总体而言，小组成员一致认为，目前主要障碍阻碍了其实施和应用。确定的序列特异性障碍是扫描时间长和缺乏标准化。其他障碍包括繁琐且耗时的分割和后处理。该研究得出结论，在临床常规中实施全心4D流MRI是可行的，但实施过程复杂，需要一个专门的多学科团队。一个预定义的计划，包括风险评估和技术验证，至关重要。报告的共识声明可能会指导进一步的工具开发，并促进更广泛的实施和临床应用。证据水平：无 技术效能：5级
