Role of 4D CMR:
With the development of 4D-flow CMR, it’s implication on the assessment of MR must also be considered. 4D-flow CMR techniques offer further improvements in the assessment of MR and are entering clinical practice. (7,39) Advantages of MR quantification with 4D-flow CMR includes a multiplanar and multi-directional retrospective analysis that allows valve tracking and reliable intra and interobserver agreement of MR.(7,40) Direct quantification of the regurgitant jet is particularly useful in pathologies involving multiple valves. A systematic review of seven studies with 4D flow-derived methods for MR quantification showed accuracy and reliability in direct measurement when compared to standard CMR techniques and establishes a complementary role with echocardiography. (41) In one retrospective study, as compared to multiplanar standard techniques for CMR, 4D flow methods had excellent correlation with high inter and intra-observer reliability. (42)