Background and Objective: Plane reformatting for four-dimensional phase contrast MRI (4D flow MRI) is time-consuming and prone to inter-observer variability, which limits fast cardiovascular flow assessment. Deep reinforcement learning (DRL) trains agents to iteratively adjust plane position and orientation, enabling accurate plane reformatting without the need for detailed landmarks, making it suitable for images with limited contrast and resolution such as 4D flow MRI. However, current DRL methods assume that test volumes share the same spatial alignment as the training data, limiting generalization across scanners and institutions. To address this limitation, we introduce AdaPR (Adaptive Plane Reformatting), a DRL framework that uses a local coordinate system to navigate volumes with arbitrary positions and orientations. Methods: We implemented AdaPR using the Asynchronous Advantage Actor-Critic (A3C) algorithm and validated it on 88 4D flow MRI datasets acquired from multiple vendors, including patients with congenital heart disease. Results: AdaPR achieved a mean angular error of 6.32 +/- 4.15 degrees and a distance error of 3.40 +/- 2.75 mm, outperforming global-coordinate DRL methods and alternative non-DRL methods. AdaPR maintained consistent accuracy under different volume orientations and positions. Flow measurements from AdaPR planes showed no significant differences compared to two manual observers, with excellent correlation (R^2 = 0.972 and R^2 = 0.968), comparable to inter-observer agreement (R^2 = 0.969). Conclusion: AdaPR provides robust, orientation-independent plane reformatting for 4D flow MRI, achieving flow quantification comparable to expert observers. Its adaptability across datasets and scanners makes it a promising candidate for medical imaging applications beyond 4D flow MRI.

Time-resolved three-dimensional phase-contrast MRI (4D Flow MRI) enables non-invasive quantification of blood flow and derivation of hemodynamic parameters. However, its clinical application is limited by low spatial resolution and noise, particularly a ffecting velocity measurements near vessel walls. Machine learning-based super-resolution has shown promise in addressing these limitations, but challenges remain, not least in recovering near-wall velocities. Generative adversarial networks (GANs) o ff er a compelling solution, having demonstrated strong capabilities in restoring sharp boundaries in non-medical super-resolution settings. Y et, their application in 4D Flow MRI remains unexplored, with implementation challenged by known issues such as training instability and non-convergence. In this study, we investigate GAN-based super-resolution and denoising in 4D Flow MRI. Training and validation were conducted using patient-specific cerebrovascular in-silico models, converted into synthetic images via an MR-true reconstruction pipeline. A dedicated GAN architecture was implemented and evaluated across three adversarial loss functions: V anilla, Relativistic, and Wasserstein. Our results demonstrate that the proposed GAN improved near-wall velocity recovery compared to a non-adversarial reference (vNRMSE: 6.9% vs. 9.6%); however, that implementation specifics are critical for stable network training. While V anilla and Relativistic GANs proved unstable compared to generator-only training (vNRMSE: 8.1% and 7.8% vs. 7.2%), a Wasserstein GAN demonstrated optimal stability and incremental improvement (vNRMSE: 6.9% vs. 7.2%). Introduction Single image super-resolution (SISR) is the task of reconstructing a high-resolution (HR) image from its low-resolution (LR) counterpart, recovering features blurred or not fully conveyed in the input LR data. While traditional deterministic methods have been extensively studied [4, 5, 6], deep learning approaches - particularly those based on convolutional neural networks (CNNs) - have become the dominant strategy owing to their ability to learn complex spatial mappings directly from data [6, 7, 8, 9, 10, 11, 12]. In recent years, both network architectures and training strategies have evolved significantly in this domain [8, 9, 12, 13, 14, 15], consistently improving super-resolution performance.

In recent decades, the use of 4D Flow MRI images has enabled the quantification of velocity fields within a volume of interest and along the cardiac cycle. However, the lack of resolution and the presence of noise in these biomarkers are significant issues. As indicated by recent studies, it appears that biomarkers such as wall shear stress are particularly impacted by the poor resolution of vessel segmentation. The Phase Contrast Magnetic Resonance Angiography (PC-MRA) is the state-of-the-art method to facilitate segmentation. The objective of this work is to introduce a new handcraft feature that provides a novel visualisation of 4D Flow MRI images, which is useful in the segmentation task. This feature, termed Weighted Mean Frequencies (WMF), is capable of revealing the region in three dimensions where a voxel has been passed by pulsatile flow. Indeed, this feature is representative of the hull of all pulsatile velocity voxels. The value of the feature under discussion is illustrated by two experiments. The experiments involved segmenting 4D Flow MRI images using optimal thresholding and deep learning methods. The results obtained demonstrate a substantial enhancement in terms of IoU and Dice, with a respective increase of 0.12 and 0.13 in comparison with the PC-MRA feature, as evidenced by the deep learning task. This feature has the potential to yield valuable insights that could inform future segmentation processes in other vascular regions, such as the heart or the brain.

4D Flow Magnetic Resonance Imaging (4D Flow MRI) is a non-invasive technique for volumetric, time-resolved blood flow quantification. However, apparent trade-offs between acquisition time, image noise, and resolution limit clinical applicability. In particular, in regions of highly transient flow, coarse temporal resolution can hinder accurate capture of physiologically relevant flow variations. To overcome these issues, post-processing techniques using deep learning have shown promising results to enhance resolution post-scan using so-called super-resolution networks. However, while super-resolution has been focusing on spatial upsampling, temporal super-resolution remains largely unexplored. The aim of this study was therefore to implement and evaluate a residual network for temporal super-resolution 4D Flow MRI. To achieve this, an existing spatial network (4DFlowNet) was re-designed for temporal upsampling, adapting input dimensions, and optimizing internal layer structures. Training and testing were performed using synthetic 4D Flow MRI data originating from patient-specific in-silico models, as well as using in-vivo datasets. Overall, excellent performance was achieved with input velocities effectively denoised and temporally upsampled, with a mean absolute error (MAE) of 1.0 cm/s in an unseen in-silico setting, outperforming deterministic alternatives (linear interpolation MAE = 2.3 cm/s, sinc interpolation MAE = 2.6 cm/s). Further, the network synthesized high-resolution temporal information from unseen low-resolution in-vivo data, with strong correlation observed at peak flow frames. As such, our results highlight the potential of utilizing data-driven neural networks for temporal super-resolution 4D Flow MRI, enabling high-frame-rate flow quantification without extending acquisition times beyond clinically acceptable limits.

Hemodynamic quantities are valuable biomedical risk factors for cardiovascular pathology such as atherosclerosis. Non-invasive, in-vivo measurement of these quantities can only be performed using a select number of modalities that are not widely available, such as 4D flow magnetic resonance imaging (MRI). In this work, we create a surrogate model for hemodynamic flow field estimation, powered by machine learning. We train graph neural networks that include priors about the underlying symmetries and physics, limiting the amount of data required for training. This allows us to train the model using moderately-sized, in-vivo 4D flow MRI datasets, instead of large in-silico datasets obtained by computational fluid dynamics (CFD), as is the current standard. We create an efficient, equivariant neural network by combining the popular PointNet++ architecture with group-steerable layers. To incorporate the physics-informed priors, we derive an efficient discretisation scheme for the involved differential operators. We perform extensive experiments in carotid arteries and show that our model can accurately estimate low-noise hemodynamic flow fields in the carotid artery. Moreover, we show how the learned relation between geometry and hemodynamic quantities transfers to 3D vascular models obtained using a different imaging modality than the training data. This shows that physics-informed graph neural networks can be trained using 4D flow MRI data to estimate blood flow in unseen carotid artery geometries.

4D Flow Magnetic Resonance Imaging (4D Flow MRI) is a non-invasive measurement technique capable of quantifying blood flow across the cardiovascular system. While practical use is limited by spatial resolution and image noise, incorporation of trained super-resolution (SR) networks has potential to enhance image quality post-scan. However, these efforts have predominantly been restricted to narrowly defined cardiovascular domains, with limited exploration of how SR performance extends across the cardiovascular system; a task aggravated by contrasting hemodynamic conditions apparent across the cardiovasculature. The aim of our study was to explore the generalizability of SR 4D Flow MRI using a combination of heterogeneous training sets and dedicated ensemble learning. With synthetic training data generated across three disparate domains (cardiac, aortic, cerebrovascular), varying convolutional base and ensemble learners were evaluated as a function of domain and architecture, quantifying performance on both in-silico and acquired in-vivo data from the same three domains. Results show that both bagging and stacking ensembling enhance SR performance across domains, accurately predicting high-resolution velocities from low-resolution input data in-silico. Likewise, optimized networks successfully recover native resolution velocities from downsampled in-vivo data, as well as show qualitative potential in generating denoised SR-images from clinical level input data. In conclusion, our work presents a viable approach for generalized SR 4D Flow MRI, with ensemble learning extending utility across various clinical areas of interest.

4D flow MRI is a non-invasive imaging method that can measure blood flow velocities over time. However, the velocity fields detected by this technique have limitations due to low resolution and measurement noise. Coordinate-based neural networks have been researched to improve accuracy, with SIRENs being suitable for super-resolution tasks. Our study investigates SIRENs for time-varying 3-directional velocity fields measured in the aorta by 4D flow MRI, achieving denoising and super-resolution. We trained our method on voxel coordinates and benchmarked our approach using synthetic measurements and a real 4D flow MRI scan. Our optimized SIREN architecture outperformed state-of-the-art techniques, producing denoised and super-resolved velocity fields from clinical data. Our approach is quick to execute and straightforward to implement for novel cases, achieving 4D super-resolution.

In this paper, we explored the use of deep learning for the prediction of aortic flow metrics obtained using 4D flow MRI using wearable seismocardiography (SCG) devices. 4D flow MRI provides a comprehensive assessment of cardiovascular hemodynamics, but it is costly and time-consuming. We hypothesized that deep learning could be used to identify pathological changes in blood flow, such as elevated peak systolic velocity Vmax in patients with heart valve diseases, from SCG signals. We also investigated the ability of this deep learning technique to differentiate between patients diagnosed with aortic valve stenosis (AS), non-AS patients with a bicuspid aortic valve (BAV), non-AS patients with a mechanical aortic valve (MAV), and healthy subjects with a normal tricuspid aortic valve (TAV). In a study of 77 subjects who underwent same-day 4D flow MRI and SCG, we found that the Vmax values obtained using deep learning and SCGs were in good agreement with those obtained by 4D flow MRI. Additionally, subjects with TAV, BAV, MAV, and AS could be classified with ROC-AUC values of 92%, 95%, 81%, and 83%, respectively. This suggests that SCG obtained using low-cost wearable electronics may be used as a supplement to 4D flow MRI exams or as a screening tool for aortic valve disease.