Share：
Share this content in WeChat
X
[Chinese] [PDF] 6 1
• Reviews •
Research progress on 4D Flow CMR in evaluating myocardial infarction
LI Yan  WANG Shaozhe  LIU Fenghai  LI Guoce  PAN Zhibin  BIAN Hao  ZHANG Lei  KANG Liqing  ZHANG Houning  ZHANG Bin  WANG Sicong 

Cite this article as: LI Y, WANG S Z, LIU F H, et al. Research progress on 4D Flow CMR in evaluating myocardial infarction[J]. Chin J Magn Reson Imaging, 2026, 17(3): 194-200. DOI:10.12015/issn.1674-8034.2026.03.028.


[Abstract] Myocardial infarction remains a leading cause of death worldwide, making the assessment of intracardiac hemodynamics essential for its diagnosis and management. Four-dimensional flow cardiac magnetic resonance (4D Flow CMR) has emerged as a promising non-invasive imaging technique capable of capturing comprehensive, multi-parametric, and dynamic blood flow information across the entire heart. Although increasingly applied in myocardial infarction research in recent years, a systematic synthesis of advances in this field is still lacking. This review focuses on the application of 4D Flow CMR in myocardial infarction, with emphasis on five key hemodynamic aspects: kinetic energy (KE) and flow components, vortex and vorticity analysis, pressure gradient quantification, myocardial blood flow (MBF), and pulse wave velocity (PWV). It summarizes the characteristic hemodynamic parameters revealed by this technology and discusses their clinical implications. Current limitations are also addressed, including prolonged scan times, complex post-processing, limited validation methods, and insufficient standardization. Future directions to facilitate clinical translation are highlighted, such as workflow automation, multi-center standardization, and integration with artificial intelligence. By systematically organizing the current evidence on 4D Flow CMR in hemodynamic evaluation related to myocardial infarction, this review aims to provide imaging-based support for early intervention, treatment response assessment, and prognostic evaluation, while offering a reference for further research and broader clinical adoption of the technology.
[Keywords] magnetic resonance imaging；four-dimensional flow cardiac magnetic resonance；myocardial infarction；hemodynamics；quantitative analysis

LI Yan1   WANG Shaozhe1   LIU Fenghai1*   LI Guoce1   PAN Zhibin1   BIAN Hao1   ZHANG Lei1   KANG Liqing1   ZHANG Houning2   ZHANG Bin3   WANG Sicong4  

1 Department of Magnetic Resonance Imaging, Cangzhou Central Hospital Affiliated to Hebei Medical University, Cangzhou 061000, China

2 The First Department of Magnetic Resonance Imaging, Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, China

3 Department of Medical Imaging, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China

4 GE Healthcare China, Beijing 102600, China

Corresponding author: LIU F H, E-mail: lfh600@126.com

Conflicts of interest   None.

Received  2025-10-24
Accepted  2026-01-04
DOI: 10.12015/issn.1674-8034.2026.03.028
Cite this article as: LI Y, WANG S Z, LIU F H, et al. Research progress on 4D Flow CMR in evaluating myocardial infarction[J]. Chin J Magn Reson Imaging, 2026, 17(3): 194-200. DOI:10.12015/issn.1674-8034.2026.03.028.

[1]
GOLDSBOROUGH E, OSUJI N, BLAHA M J. Assessment of cardiovascular disease risk a 2022 update[J]. Endocrinol Metab Clin N Am, 2022, 51(3): 483-509. DOI: 10.1016/j.ecl.2022.02.005.
[2]
WANG X, PU J. Recent advances in cardiac magnetic resonance for imaging of acute myocardial infarction[J/OL]. Small Methods, 2024, 8(3): e2301170 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37992241/. DOI: 10.1002/smtd.202301170.
[3]
CALVIERI C, RIVA A, STURLA F, et al. Left ventricular adverse remodeling in ischemic heart disease: emerging cardiac magnetic resonance imaging biomarkers[J/OL]. J Clin Med, 2023, 12(1): 334 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/36615133/. DOI: 10.3390/jcm12010334.
[4]
KAMANI C H, LWIN M, BOTIS I, et al. Left ventricular flow kinetics and myocardial deformation following acute infarction: Additional predictive value of cardiac magnetic resonance four-dimensional flow for left ventricular remodeling post-ST-elevation myocardial infarction[J/OL]. J Cardiovasc Magn Reson, 2025, 27(2): 101905 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/40345668/. DOI: 10.1016/j.jocmr.2025.101905.
[5]
DEMIRKIRAN A, VAN DER GEEST R J, HOPMAN L H G A, et al. Association of left ventricular flow energetics with remodeling after myocardial infarction: New hemodynamic insights for left ventricular remodeling[J/OL]. Int J Cardiol, 2022, 367: 105-114 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/36007668/. DOI: 10.1016/j.ijcard.2022.08.040.
[6]
KHERADVAR A, PEDRIZZETTI G. State of energy of ventricular flow: a cause or the first indicator of adverse remodeling [J/OL]. Int J Cardiol, 2023, 371: 490-491 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/36162524/. DOI: 10.1016/j.ijcard.2022.09.042.
[7]
DEMIRKIRAN A, VAN OOIJ P, WESTENBERG J J M, et al. Clinical intra-cardiac 4D flow CMR: acquisition, analysis, and clinical applications[J]. Eur Heart J Cardiovasc Imaging, 2022, 23(2): 154-165. DOI: 10.1093/ehjci/jeab112.
[8]
MAROUN A, QUINN S, DUSHFUNIAN D, et al. Clinical applications of four-dimensional flow MRI[J]. Magn Reson Imaging Clin N Am, 2023, 31(3): 451-460. DOI: 10.1016/j.mric.2023.04.005.
[9]
BISSELL M M, RAIMONDI F, AIT ALI L, et al. 4D Flow cardiovascular magnetic resonance consensus statement: 2023 update[J/OL]. J Cardiovasc Magn Reson, 2023, 25(1): 40 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37474977/. DOI: 10.1186/s12968-023-00942-z.
[10]
WIEBEN O, ROBERTS G S, CORRADO P A, et al. Four-dimensional flow MR imaging: technique and advances[J]. Magn Reson Imaging Clin N Am, 2023, 31(3): 433-449. DOI: 10.1016/j.mric.2023.05.003.
[11]
BRUSCHEWSKI M, KOLKMANNN H, JOHN K, et al. Phase-contrast single-point imaging with synchronized encoding: a more reliable technique for in vitro flow quantification[J]. Magn Reson Med, 2019, 81(5): 2937-2946. DOI: 10.1002/mrm.27604.
[12]
OECHTERING T H, NOWAK A, SIEREN M M, et al. Repeatability and reproducibility of various 4D Flow MRI postprocessing software programs in a multi-software and multi-vendor cross-over comparison study[J/OL]. J Cardiovasc Magn Reson, 2023, 25(1): 22 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/36978131/. DOI: 10.1186/s12968-023-00921-4.
[13]
PUNZO B, RANIERI B, TRAMONTANO L, et al. 4D-flow cardiovascular magnetic resonance sequence for aortic assessment: multi-vendor and multi-magnetic field reproducibility in healthy volunteers[J/OL]. J Clin Med, 2023, 12(8): 2960 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37109295/. DOI: 10.3390/jcm12082960.
[14]
KAUR H, ASSADI H, ALABED S, et al. Left ventricular blood flow kinetic energy assessment by 4D flow cardiovascular magnetic resonance: a systematic review of the clinical relevance[J/OL]. J Cardiovasc Dev Dis, 2020, 7(3): 37 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/32927744/. DOI: 10.3390/jcdd7030037.
[15]
QIN J J, INDJA B, GHOLIPOUR A, et al. Evaluation of left ventricular function using four-dimensional flow cardiovascular magnetic resonance: a systematic review[J/OL]. J Cardiovasc Dev Dis, 2022, 9(9): 304 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/36135449/. DOI: 10.3390/jcdd9090304.
[16]
GARG P, CRANDON S, SWOBODA P P, et al. Left ventricular blood flow kinetic energy after myocardial infarction - insights from 4D flow cardiovascular magnetic resonance[J/OL]. J Cardiovasc Magn Reson, 2018, 20(1): 61 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/30165869/. DOI: 10.1186/s12968-018-0483-6.
[17]
NIU X Q, DUN Y T, LI G C, et al. Evaluation of left ventricular blood flow kinetic energy in patients with acute myocardial infarction by 4D Flow MRI: a preliminary study[J/OL]. BMC Med Imaging, 2024, 24(1): 131 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/38840059/. DOI: 10.1186/s12880-024-01310-8.
[18]
GARG P, VAN DER GEEST R J, SWOBODA P P, et al. Left ventricular thrombus formation in myocardial infarction is associated with altered left ventricular blood flow energetics[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(1): 108-117. DOI: 10.1093/ehjci/jey121.
[19]
BEN-ARZI H, DAS A, KELLY C, et al. Longitudinal changes in left ventricular blood flow kinetic energy after myocardial infarction: predictive relevance for cardiac remodeling[J]. J Magn Reson Imaging, 2022, 56(3): 768-778. DOI: 10.1002/jmri.28015.
[20]
GISSLER M C, ANTIOCHOS P, GE Y, et al. Cardiac magnetic resonance evaluation of LV remodeling post-myocardial infarction: prognosis, monitoring and trial endpoints[J]. JACC Cardiovasc Imaging, 2024, 17(11): 1366-1380. DOI: 10.1016/j.jcmg.2024.03.012.
[21]
DAS A, KELLY C, BEN-ARZI H, et al. Acute intra-cavity 4D flow cardiovascular magnetic resonance predicts long-term adverse remodelling following ST-elevation myocardial infarction[J/OL]. J Cardiovasc Magn Reson, 2022, 24(1): 64 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/36404326/. DOI: 10.1186/s12968-022-00889-7.
[22]
BOLGER A F, HEIBERG E, KARLSSON M, et al. Transit of blood flow through the human left ventricle mapped by cardiovascular magnetic resonance[J]. J Cardiovasc Magn Reson, 2007, 9(5): 741-747. DOI: 10.1080/10976640701544530.
[23]
ZHAO X D, TAN R S, GARG P, et al. Age- and sex-specific reference values of biventricular flow components and kinetic energy by 4D flow cardiovascular magnetic resonance in healthy subjects[J/OL]. J Cardiovasc Magn Reson, 2023, 25(1): 50 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37718441/. DOI: 10.1186/s12968-023-00960-x.
[24]
DEMIRKIRAN A, HASSELL M E C J, GARG P, et al. Left ventricular four-dimensional blood flow distribution, energetics, and vorticity in chronic myocardial infarction patients with/without left ventricular thrombus[J/OL]. Eur J Radiol, 2022, 150: 110233 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/35278980/. DOI: 10.1016/j.ejrad.2022.110233.
[25]
CORRADO P A, MACDONALD J A, FRANÇOIS C J, et al. Reduced regional flow in the left ventricle after anterior acute myocardial infarction: a case control study using 4D flow MRI[J/OL]. BMC Med Imaging, 2019, 19(1): 101 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/31888531/. DOI: 10.1186/s12880-019-0404-7.
[26]
LEO I, CERSOSIMO A, IELAPI J, et al. Intracardiac fluid dynamic analysis: available techniques and novel clinical applications[J/OL]. BMC Cardiovasc Disord, 2024, 24(1): 716 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/39702022/. DOI: 10.1186/s12872-024-04371-3.
[27]
SUWA K, SAITOH T, TAKEHARA Y, et al. Intra-left ventricular flow dynamics in patients with preserved and impaired left ventricular function: Analysis with 3D cine phase contrast MRI (4D-Flow)[J]. J Magn Reson Imaging, 2016, 44(6): 1493-1503. DOI: 10.1002/jmri.25315.
[28]
SCHÄFER M, BARKER A J, MORGAN G J, et al. Increased systolic vorticity in the left ventricular outflow tract is associated with abnormal aortic flow formations in Tetralogy of Fallot[J]. Int J Cardiovasc Imaging, 2020, 36(4): 691-700. DOI: 10.1007/s10554-019-01764-w.
[29]
BORHANI A, PORTER K K, UMAIR M, et al. Quantifying 4D flow cardiovascular magnetic resonance vortices in patients with pulmonary hypertension: a pilot study[J/OL]. Pulm Circ, 2023, 13(4): e12298 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37859803/. DOI: 10.1002/pul2.12298.
[30]
CAIN M T, SCHÄFER M, ROSS L K, et al. 4D-Flow MRI intracardiac flow analysis considering different subtypes of pulmonary hypertension[J/OL]. Pulm Circ, 2023, 13(4): e12307 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37941938/. DOI: 10.1002/pul2.12307.
[31]
RIVA A, SAITTA S, STURLA F, et al. Left ventricle diastolic Vortex ring characterization in ischemic cardiomyopathy: insight into atrio-ventricular interplay[J]. Med Biol Eng Comput, 2024, 62(12): 3671-3685. DOI: 10.1007/s11517-024-03154-4.
[32]
LOKE Y H, CAPUANO F, CLEVELAND V, et al. Moving beyond size: vorticity and energy loss are correlated with right ventricular dysfunction and exercise intolerance in repaired Tetralogy of Fallot[J/OL]. J Cardiovasc Magn Reson, 2021, 23(1): 98 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/34412634/. DOI: 10.1186/s12968-021-00789-2.
[33]
OTA H, KAMADA H, HIGUCHI S, et al. Clinical application of 4D flow MR imaging to pulmonary hypertension[J]. Magn Reson Med Sci, 2022, 21(2): 309-318. DOI: 10.2463/mrms.rev.2021-0111.
[34]
POLA K, ROIJER A, BORGQUIST R, et al. Hemodynamic forces from 4D flow magnetic resonance imaging predict left ventricular remodeling following cardiac resynchronization therapy[J/OL]. J Cardiovasc Magn Reson, 2023, 25(1): 45 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37620886/. DOI: 10.1186/s12968-023-00955-8.
[35]
VALLELONGA F, AIRALE L, TONTI G, et al. Introduction to hemodynamic forces analysis: moving into the new frontier of cardiac deformation analysis[J/OL]. J Am Heart Assoc, 2021, 10(24): e023417 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/34889114/. DOI: 10.1161/JAHA.121.023417.
[36]
HAN Y C, BOWEN D J, BARRETO B L, et al. Vortices and hemodynamic forces in the left ventricle: comparison between high frame rate echo-particle image velocimetry and 4D flow MRI[J]. Ultrasound Med Biol, 2025, 51(10): 1805-1813. DOI: 10.1016/j.ultrasmedbio.2025.06.023.
[37]
LANGE T, BACKHAUS S J, SCHULZ A, et al. Inter-study reproducibility of cardiovascular magnetic resonance-derived hemodynamic force assessments[J/OL]. Sci Rep, 2024, 14(1): 634 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/38182625/. DOI: 10.1038/s41598-023-50405-9.
[38]
POLA K, ASHKIR Z, MYERSON S, et al. Flow inefficiencies in non-obstructive HCM revealed by kinetic energy and hemodynamic forces on 4D-flow CMR[J/OL]. Eur Heart J Imaging Methods Pract, 2024, 2(3): qyae074 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/39210991/. DOI: 10.1093/ehjimp/qyae074.
[39]
FILOMENA D, CIMINO S, MONOSILIO S, et al. Impact of intraventricular haemodynamic forces misalignment on left ventricular remodelling after myocardial infarction[J]. ESC Heart Fail, 2022, 9(1): 496-505. DOI: 10.1002/ehf2.13719.
[40]
ENDO K, FUKUSHIMA K, KATAHIRA M, et al. Left ventricular diastolic inflow and myocardial flow reserve in patients with coronary artery disease: simultaneous analysis of 4D-Flow and myocardial perfusion using hybrid PETMR[J]. Int J Cardiovasc Imaging, 2025, 41(6): 1075-1083. DOI: 10.1007/s10554-025-03387-w.
[41]
SHARKA I, PANICHELLA G, GRIGORATOS C, et al. Myocardial perfusion imaging with cardiovascular magnetic resonance in nonischemic cardiomyopathies: an in-depth review of techniques and clinical applications[J/OL]. Medicina, 2025, 61(5): 875 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/40428833/. DOI: 10.3390/medicina61050875.
[42]
GOSLING R C, WILLIAMS G, BARAIKAN A AL, et al. Quantifying myocardial blood flow and resistance using 4D-flow cardiac magnetic resonance imaging[J/OL]. Cardiol Res Pract, 2023, 2023: 3875924 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/36776959/. DOI: 10.1155/2023/3875924.
[43]
NGUYEN L A, HOURIEZ-GOMBAUD-SAINTONGE S, PUYMIRAT E, et al. Aortic stiffness measured from either 2D/4D flow and cine MRI or applanation tonometry in coronary artery disease: a case-control study[J/OL]. J Clin Med, 2023, 12(11): 3643 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37297837/. DOI: 10.3390/jcm12113643.
[44]
PARK S, KWON M, NAM H, et al. Interpolation time-optimized aortic pulse wave velocity estimation by 4D flow MRI[J/OL]. Sci Rep, 2023, 13(1): 16484 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37777620/. DOI: 10.1038/s41598-023-43799-z.
[45]
LIU G Y, SHA W Y, WU Y Y, et al. The association between estimated pulse wave velocity and cardio-cerebrovascular disease risk: a cohort study[J/OL]. Eur J Med Res, 2025, 30(1): 16 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/39780263/. DOI: 10.1186/s40001-024-02217-4.
[46]
MEISZTERICS Z, SIMOR T, VAN DER GEEST R J, et al. Evaluation of pulse wave velocity for predicting major advanced cardiovascular events in patients with chronic myocardial infarction[J/OL]. Eur Heart J, 2021, 42(Supplement_1): ehab724.2533 [2025-10-23]. https://academic.oup.com/eurheartj/article/42/Supplement_1/ehab724.2533/6392017. DOI: 10.1093/eurheartj/ehab724.2533.
[47]
AGHEZZAF S, COISNE A, BAUTERS C, et al. Feasibility and prognostic significance of ventricular-arterial coupling after myocardial infarction: the RIGID-MI cohort[J]. Eur Heart J Cardiovasc Imaging, 2024, 25(5): 668-677. DOI: 10.1093/ehjci/jead342.
[48]
VÁCLAVŮ L. Editorial for "intracranial blood flow quantification by accelerated dual-venc 4D flow MRI: comparison with transcranial Doppler ultrasound"[J]. J Magn Reson Imaging, 2022, 56(4): 1265-1266. DOI: 10.1002/jmri.28146.
[49]
FICO B G, MILLER K B, RIVERA-RIVERA L A, et al. Cerebral hemodynamics comparison using transcranial Doppler ultrasound and 4D flow MRI[J/OL]. Front Physiol, 2023, 14: 1198615 [2025-10-23]. https://pubmed.ncbi.nlm.nih.gov/37304825/. DOI: 10.3389/fphys.2023.1198615.
[50]
HAN Y C, BOWEN D J, BARRETO B L, et al. Validation of left ventricular high frame rate echo-particle image velocimetry against 4D flow MRI in patients[J]. Ultrasound Med Biol, 2025, 51(1): 94-101. DOI: 10.1016/j.ultrasmedbio.2024.09.012.
[51]
ZHUANG B Y, SIRAJUDDIN A, ZHAO S H, et al. The role of 4D flow MRI for clinical applications in cardiovascular disease: current status and future perspectives[J]. Quant Imaging Med Surg, 2021, 11(9): 4193-4210. DOI: 10.21037/qims-20-1234.
[52]
VARGA-SZEMES A, HALFMANN M, SCHOEPF U J, et al. Highly accelerated compressed-sensing 4D flow for intracardiac flow assessment[J]. J Magn Reson Imaging, 2023, 58(2): 496-507. DOI: 10.1002/jmri.28484.
[53]
BERHANE H, SCOTT M, ELBAZ M, et al. Fully automated 3D aortic segmentation of 4D flow MRI for hemodynamic analysis using deep learning[J]. Magn Reson Med, 2020, 84(4): 2204-2218. DOI: 10.1002/mrm.28257.

PREV Research progress of cardiac magnetic resonance feature tracking technology in the assessment of multi-chamber strain in hypertrophic cardiomyopathy
NEXT Research progress of magnetic resonance imaging combined with artificial intelligence in the precision diagnosis and treatment of cervical cancer
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn