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

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

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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.
Original languageEnglish
Pages (from-to)486-493
Number of pages8
JournalInternational Journal of Cardiology
Early online date28 Sep 2017
Publication statusPublished - Dec 2017

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