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Final Program


Program-At-A-Glance

Rapid Fire Session

Session: Rapid Fire Session 1: 4D Flow (Monitor 2)

Evaluating the Reliability of Intraventricular Flow Parameters Using 4D Flow CMR: A Multicenter Study with Healthy Volunteers from the Berlin Cardiovascular Magnetic Resonance Research Network

Thursday, February 5, 2026
10:29 AM - 10:36 AM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)
Background: Three-dimensional velocity-encoded cardiovascular magnetic resonance (4D Flow CMR) is a valuable method for assessing cardiac hemodynamics. It enables detailed evaluation of blood flow patterns, wall shear stress, and intracardiac kinetic energy, as well as precise quantification of forward and regurgitant valve flow. The technique has shown strong inter-observer reliability (1,2) and the integration is already realized in pediatric cardiology (3). This study aimed to investigate intracardiac flow dynamics and assess the comparability and reliability of these measurements across various sites.

Methods: A cohort of 20 healthy volunteers was recruited and underwent CMR imaging at three different sites within the Berlin research network for-CMR (BER-CMR) (site I: 3T MAGNETOM Skyra fit; sites II and III: 3T MAGNETOM Prisma fit, all manufactured by Siemens Healthineers, Forchheim, Germany). (4,5,6). All sites employed the same 4D Flow research sequence with the following scan parameters: Echo Time Range of 2.4-2.38ms, Temporal Resolution Range of 40.8-40.64 ms, flip angle 8° and voxel size of 2.3x2.3x2.3 mm. A compressed sensing acceleration technique was used with an acceleration factor of 7.6. Three- dimensional velocity-encoding was set to 150–200 cm/sec. Site II used a 32-channel coil, other sites used an 18-channel coil.

Assessment of Kinetic Energy (KE), Peak and Mean Velocity (PV and MV) across the left and right ventricle were conducted using MEVISFlow (Fraunhofer Institute for Digital Medicine MEVIS, software version 11.4, Bremen, Germany). Tolerance ranges for reliability assessment were defined through a scan-rescan analysis conducted at site I. Additionally, intra- and interobserver analyses for the measurements at site I were conducted to assess consistency.

Results: The final analysis included 19 healthy volunteers (11 males and 8 females). Baseline demographic and clinical characteristics are summarized in Table 1. One traveling volunteer was excluded from the study due to a newly diagnosed cardiac condition. A total of 11 scans were excluded due to technical issues, motion artifacts, or suboptimal image quality (Table 1). Despite these exclusions, inter-site comparability analysis across the right and left ventricle demonstrated strong reliability for all flow parameters in both ventricles (Figure 1). Inter- and intra-observer analyses showed that the differences in measured values were minimal, with all flow parameters displaying a narrow range of variation (Figure 2).

Conclusion: Whole-heart 4D Flow CMR measurements in healthy volunteers showed consistent results across all three sites. Despite variations such as different surface coils, there was strong agreement in intracardiac flow parameters. These results are especially significant for supporting the successful implementation of future multicenter studies.

Basic Characteristics

Site

Site I

Site I  Repositioning

Site II

Site III

N

18

17

15

13

Female/Male

8/10

8/9

6/9

7/6

Age (years)

26.3±5.9

26.4±6.1

26.8±6.3

24±3.5

Body Weight (Kg)

69.3±10.7

68.4±10.3

68.7±11.4

71.5±11.7

Height (m)

1.8±0.08

1.8±0.08

1.7±0.08

1.77±0.07

Body Mass Index (kg/min²)

22.1±2.1

21.2±2.2

21.3±2.2

22.5±2.2

Body Surface Area (m²)

1.8±0.1

1.8±0.1

1.8±0.2

1.8±0.2

Systolic Blood pressure (mmHg)

123.2±12

123±12.3

121.3±12.9

128±10.8

Diastolic Blood pressure (mmHg)

69.7±13.9

70.7±13.6

68.6±13.1

71.5±12.8

Heart rate (bpm)

68.7±12.2

68.8±12.6

68.6±13.2

65.7±9.74

Figure 1: A panel of 12 bar plots comparing various cardiac hemodynamic parameters in the left and right ventricles across three different study sites, with both intra- and interobserver variability. The grey shaded area represents the 95% tolerance range derived from both scan and rescan measurements at Site I. Each site’s results are shown as the mean deviation with corresponding 95% confidence intervals. If values fall within the tolerance range, equivalency is assumed. Parameters include peak and mean velocities, as well as maximum and mean kinetic energy in both ventricle.
Figure 2: A. Bland-Altman plots for intra- and interobserver comparison for the left ventricle at site I. The Solid black line represents the mean difference the dashed lines represent the mean difference ± 95% tolerance interval. B. Bland-Altman plots for intra- and interobserver comparison for the right ventricle at site I. The Solid black line represents the mean difference the dashed lines represent the mean difference ± 95% tolerance interval.