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In this systematic review, we aimed to depict the clinical role of intraventricular 4D-flow in MVR. The reproducibility, technical aspects, and comparison against conventional techniques were evaluated. Published studies on SCOPUS, MEDLINE, and EMBASE were included using search terms on 4D-flow CMR in MVR. Out of 420 screened articles, 18 studies fulfilled our inclusion criteria. All studies (n\u2009=\u200918, 100%) assessed MVR using 4D-flow intraventricular annular inflow (4D-flow<jats:sub>AIM<\/jats:sub>) method, which calculates the regurgitation by subtracting the aortic forward flow from the mitral forward flow. Thereof, 4D-flow jet quantification (4D-flow<jats:sub>jet<\/jats:sub>) was assessed in 5 (28%), standard 2D phase-contrast (2D-PC) flow imaging in 8 (44%) and the volumetric method (the deviation of left ventricle stroke volume and right ventricular stroke volume) in 2 (11%) studies. Inter-method correlations among the 4 MVR quantification methods were heterogeneous across studies, ranging from moderate to excellent correlations. Two studies compared 4D-flow<jats:sub>AIM<\/jats:sub> to echocardiography with moderate correlation. In 12 (63%) studies the reproducibility of 4D-flow techniques in quantifying MVR was studied. Thereof, 9 (75%) studies investigated the reproducibility of the 4D-flow<jats:sub>AIM<\/jats:sub> method and the majority (n\u2009=\u20097, 78%) reported good to excellent intra- and inter-reader reproducibility. Intraventricular 4D-flow<jats:sub>AIM<\/jats:sub> provides high reproducibility with heterogeneous correlations to conventional quantification methods. Due to the absence of a gold standard and unknown accuracies, future longitudinal outcome studies are needed to assess the clinical value of 4D-flow in the clinical setting of MVR.<\/jats:p>","DOI":"10.1007\/s10554-023-02893-z","type":"journal-article","created":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T02:01:46Z","timestamp":1686880906000},"page":"1963-1977","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Mitral valve regurgitation assessed by intraventricular CMR 4D-flow: a systematic review on the technological aspects and potential clinical applications"],"prefix":"10.1007","volume":"39","author":[{"given":"Yasaman","family":"Safarkhanlo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Bernhard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva S.","family":"Peper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond Y.","family":"Kwong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica A. 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Further, CG has received research funding from Innosuisse, Center of Artificial Intelligence in Medicine, University of Bern, Switzerland, and GAMBIT foundation. YS has received research funding from the Center of Artificial Intelligence in Medicine, University of Bern, Switzerland. BB received a career-development grant from the Swiss National Science Foundation. JB received funding from the Swiss National Science Foundation [Nr 194296]. All other authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}