Cloud-processed 4D CMR flow imaging for pulmonary flow quantification

Eur J Radiol. 2016 Oct;85(10):1849-1856. doi: 10.1016/j.ejrad.2016.07.018. Epub 2016 Jul 26.


Objectives: In this study, we evaluated a cloud-based platform for cardiac magnetic resonance (CMR) four-dimensional (4D) flow imaging, with fully integrated correction for eddy currents, Maxwell phase effects, and gradient field non-linearity, to quantify forward flow, regurgitation, and peak systolic velocity over the pulmonary artery.

Methods: We prospectively recruited 52 adult patients during one-year period from July 2014. The 4D flow and planar (2D) phase-contrast (PC) were acquired during same scanning session, but 4D flow was scanned after injection of a gadolinium-based contrast agent. Eddy-currents were semi-automatically corrected using the web-based software. Flow over pulmonary valve was measured and the 4D flow values were compared against the 2D PC ones.

Results: The mean forward flow was 92 (±30) ml/cycle measured with 4D flow and 86 (±29) ml/cycle measured with 2D PC, with a correlation of 0.82 and a mean difference of -6ml/cycle (-41-29). For the regurgitant fraction the correlation was 0.85 with a mean difference of -0.95% (-17-15). Mean peak systolic velocity measured with 4D flow was 92 (±49) cm/s and 108 (±56) cm/s with 2D PC, having a correlation of 0.93 and a mean difference of 16cm/s (-24-55).

Conclusion: 4D flow imaging post-processed with an integrated cloud-based application accurately quantifies pulmonary flow. However, it may underestimate the peak systolic velocity.

Keywords: 4D CMR flow imaging; Eddy current correction; Flow visualization; Phase contrast; Pulmonary regurgitant fraction.

MeSH terms

  • Adult
  • Blood Flow Velocity
  • Cloud Computing*
  • Contrast Media
  • Female
  • Gadolinium
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / physiopathology
  • Humans
  • Image Enhancement
  • Image Interpretation, Computer-Assisted / methods*
  • Imaging, Three-Dimensional / methods*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Prospective Studies
  • Pulmonary Valve / diagnostic imaging*
  • Pulmonary Valve / physiopathology
  • Sensitivity and Specificity


  • Contrast Media
  • Gadolinium