Table 1 Recommended 4D Flow CMR analysis for different clinical indications - all aspects below can be derived from a single acquisition. For a comprehensive overview of 4D Flow CMR quantification and visualization methodology including additional references please see recently published review articles [113–118]

Heart valve disease (stenosis, regurgitation)

Flow volume

• Identification of regurgitant and stenotic jets using streamlines and pathlines

• Regurgitant flow volumes & fraction

• Peak velocity location by systolic streamlines or maximum intensity projections of speed images

Peak velocity

• Outflow patterns using streamlines

• Estimated pressure gradients with modified Bernoulli equation

• Time course of flow curve

Shunts and collateral vessels (Ventricular-septal defect, atrial-septal defect, fistulae)

Flow volume

• Identification of shunt flow and flow directionality using pathlines

• Shunt flow volume

• Qp/Qs

Complex congenital heart disease (e.g. single ventricle physiology, Fontan circulation, Fallot’s tetralogy),

Flow volume

• Flow directionality using pathlines

• Regurgitant flow volumes & fraction

• Shunt flow using pathlines

• Flow distribution (e.g. left vs right pulmonary artery, relative SVC/IVC flow)

• Flow connectivity and distribution using pathlines

• Collateral flow volume

Peak velocity

Aortic disease (aneurysm, coarctation, dissection)

Flow volume

• Peak velocity location by systolic streamlines or maximum intensity projections of speed images

• Regurgitant flow volumes & fraction

• Identification of flow in false lumen and potential entry/exit sites

• Relative flows in true & false lumen

• Identification of highly disrupted flow patterns (likely to reduce forward flow) in tortuous aortic conditions

Peak velocity