Evolution of 4D Flow MRI Utility in Neuroradiology: A Bibliometric Analysis

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Clarke, M.D., M.S. This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5392070/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract To our knowledge, this is the first study to trend research and analyze the impact of studies exploring the neurodiagnostic utility of 4D Flow MRI. A bibliometric analysis was performed in Web of Science on September 13, 2021 using search term “4D MRI Neuroradiology” to identify and assess the 30 most-cited 4D Flow MRI neuroimaging publications in the literature from 2000–2021. The 30 most-cited articles ranged from 3 to 98 citations across 8 unique journals. The articles were published between 2007 to 2020. The top three most cited journals were American Journal of Neuroradiology (AJNR) (Impact Factor (IF) 3.825), Neuroradiology (IF 2.804), and Clinical Neuroradiology (IF 3.649). The most cited article was from 2007 by Wetzel et al. in AJNR : “In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T.” The most published first-authors in this realm included Kazuya Futami of Japan (3 first authorships), Chi-Haur Wu of the U.S. (3 first authorships), Warren Chang of the U.S., and Haruo Isoda of Japan (2 first authorships each). The most common principal pathologies addressed by the studies included cerebral arteriovenous malformations (8 articles), intracranial aneurysms (4 articles), cerebral aneurysms (3 articles), and cerebrovascular disease (2 articles). 4D flow MRI has rapidly evolved into a mainstay technology utilized for cardiac and neurologic vascular radiologic imaging. Future research in understanding of the neurodiagnostic utility of 4D Flow would improve diagnosis and treatment planning of neurologic and neurosurgical disorders, particularly those of cerebrovascular etiology. Neurology 4D Flow MRI Neuroradiology Neurosurgery Diagnostic Radiology INTRODUCTION Cerebrovascular atherosclerosis may result in cerebrovascular disease such as stroke, small vessel disease, and/or vascular dementia, while microvascular damage and arterial wall remodeling may be implicated in neurodegenerative diseases.[ 1 , 2 ] Examination of blood flow in the cerebral vasculature yields signs of early disease and characterizes the extent of damage in advanced cases.[ 2 ] Quantitative measurements of blood flow in cerebral arteries and veins may allow investigators to better understand and treat cerebrovascular disease. Magnetic resonance imaging (MRI) is an essential tool for evaluating morphology and function in patients with diseases of the intracranial vasculature. Phase-contrast MRI, which is generally acquired in two spatial dimensions and one temporal dimension correcting for the cardiac phase, can measure fluid velocity in major blood vessels.[ 1 ] An advanced phase-contrast MRI technique known as 4D phase-contrast MRI or 4D flow MRI was created to allow quantitative in vivo 3D flow assessment by capturing velocities in the three cardinal directions.[ 1 – 3 ] Despite early challenges, this modality has enjoyed increased interest in recent years.[ 4 ] As the benefits of 4D flow MRI are getting increasingly established, its use in normal and pathological states has increased in research and clinical practice. Given the emerging role of 4D MRI in neuroradiology, we investigated the 30 most-cited publications on the topic in the English-language literature to compile demographics of these studies, examine common pathologies and topics, and present existing and emerging uses of 4D flow MRI in clinical neuroradiological practice. This study will increase understanding of the role of this technology among neuroradiologists and promote further research to maximize the clinical utility of 4D flow MRI. METHODS A bibliometric analysis was performed on September 13, 2021. A title-specific word search with the term “4D MRI Neuroradiology” was conducted using the Web of Science (WoS) database to identify the most influential research publications on 4D MRI. The search yielded 231 total articles. Articles were then sorted in descending order by number of citations. The articles ranked 1–30 were included in the analysis. Bibliometric and demographic variables were extracted from each WoS article. These included publication title, publication first author, number of authors, number of citations, year of publication, journal, journal impact factor (2020), WoS categories, decade of publication, country of first author, United States (US) region of first author for papers written by US authors, and pathology examined. IBM SPSS Version 26 (SPSS Inc., Chicago, IL) was used to perform analyses of frequencies, sums, and means. RESULTS Of 231 articles retrieved in the search, total of 30 articles with 3 to 98 citations were included in this analysis (Table 1 ). Table 1 Top 30 Most Cited Papers on 4D Flow MRI Most Cited Rank Title Journal First Author Year Total Citations Web of Science Categories 1 In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T American Journal of Neuroradiology Wetzel, Sandrine 2007 98 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 2 Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics Neuroradiology Isoda, Haruo 2010 74 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 3 Intracranial 4D flow MRI: Toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes American Journal of Neuroradiology Ansari, Sameer A. 2013 63 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 4 In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI Neuroradiology Isoda, Haruo 2010 55 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 5 Comparison of blood flow velocity quantification by 4D flow MR imaging with ultrasound at the carotid bifurcation American Journal of Neuroradiology Harloff, Andreas 2013 47 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 6 Complete intracranial arterial and venous blood flow evaluation with 4D flow MR imaging American Journal of Neuroradiology Hope, Michael 2009 44 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 7 Intracranial artery velocity measurement using 4D PC MRI at 3 T: comparison with trans cranial ultrasound techniques and 2D PC MRI Neuroradiology Meckel, Stephan 2013 38 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 8 Dampening of blood-flow pulsatility along the carotid siphon: Does form follow function? American Journal of Neuroradiology Schubert, Tilman 2011 34 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 9 Magnetic particle imaging for high temporal resolution assessment of aneurysm hemodynamics Plos One Sedlacik, Jan 2016 32 Science & Technology - Other Topics 10 Dynamic 4D MRI for characterization of parathyroid adenomas: Multiparametric analysis American Journal of Neuroradiology Nael, Kambiz 2015 30 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 11 Evaluation of 4D vascular flow and tissue perfusion in cerebral arteriovenous malformations: Influence of Spetzler-Martin grade, clinical presentation, and AVM risk factors American Journal of Neuroradiology Wu, Chi-Haur 2015 28 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 12 Fast contrast-enhanced 4D MRA and 4D flow MRI using constrained reconstruction (HYPERFlow): Potential applications for brain arteriovenous malformations American Journal of Neuroradiology Chang, Warren 2015 19 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 13 4D flow MRI assessment of extracranial-intracranial bypass: qualitative and quantitative evaluation of the hemodynamics Neuroradiology Sekine, Tetsuro 2016 14 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 14 Identification of inflow zone of unruptured cerebral aneurysms: comparison of 4D flow MRI and 3D TOF MRA data American Journal of Neuroradiology Futami, Kazuya 2014 13 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 15 In vivo assessment of the impact of regional intracranial atherosclerotic lesions on brain arterial 3D hemodynamics American Journal of Neuroradiology Wu, Chi-Haur 2017 12 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 16 Pressure mapping and hemodynamic assessment of intracranial dural sinuses and dural arteriovenous fistulas with 4D flow MRI American Journal of Neuroradiology Rivera-Rivera, Leonardo 2018 11 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 17 Early hemodynamic response assessment of stereotactic radiosurgery for a cerebral arteriovenous malformation using 4D flow MRI American Journal of Neuroradiology Li, Charles Q. 2018 11 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 18 Emerging techniques for evaluation of the hemodynamics of intracranial vascular pathology Neuroradiology Journal Chang, Warren 2015 10 Neuroimaging 19 FLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion Neuroradiology Forester, Alex 2014 9 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 20 Inflow jet patterns of unruptured cerebral aneurysms based on the flow velocity in the parent artery: Evaluation using 4D flow MRI American Journal of Neuroradiology Futami, Kazuya 2016 8 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 21 Fast 4D flow MRI re-emerges as a potential clinical tool for neuroradiology American Journal of Neuroradiology Turski, Patrick 2013 7 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 22 How flow reduction influences the intracranial aneurysm occlusion: A prospective 4D phase-contrast MRI study American Journal of Neuroradiology Brina, Olivier 2019 7 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 23 Large neck and strong ostium inflow as the potential causes for delayed occlusion of unruptured sidewall intracranial aneurysms treated by flow diverter American Journal of Neuroradiology Su, Tianhao 2020 6 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 24 Optimization of the surgical approach in AVMs using MRI and 4D DSA Fusion Technique Clinical Neuroradiology Trite, Stephanie 2017 5 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 25 4D dynamic contrast-enhanced MRI for preoperative localization in patients with primary hyperparathyroidism American Journal of Neuroradiology Becker, Jennifer 2020 5 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 26 Identification of vortex cores in cerebral aneurysms on 4D flow MRI American Journal of Neuroradiology Futami, Kazuya 2019 4 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging 27 Follow-up MRI for small brain AVMs treated by radiosurgery: Is gadolinium really necessary? American Journal of Neuroradiology Leclerc, Xavier 2020 4 Clinical Neurology; Neuroimaging; Radiology, Nuclear Medicine & Medical Imaging 28 Combined DSA and 4D flow demonstrate overt alterations of vascular geometry and hemodynamics in an unusually complex cerebral AVM Clinical Neuroradiology Wu, Chi-Haur 2016 4 Clinical Neuroradiology 29 Feasibility of noninvasive diagnosis and treatment planning in a case series with carotid-cavernous fistula using high-resolution time-resolved MR-angiography with stochastic trajectories (TWIST) and extended parallel acquisition technique (ePAT 6) at 3 T Clinical Neuroradiology Seeger, Achim 2015 4 Clinical Neurology; Radiology, Nuclear Medicine & Medical Imaging 30 High spatiotemporal resolution 4D flow MRI of intracranial aneurysms at 7T in 10 minutes American Journal of Neuroradiology Gottwald, Lukas 2020 3 Neurosciences & Neurology; Radiology, Nuclear Medicine & Medical Imaging All articles were published between 2007 and 2020. Articles were published across five unique journals (Table 2 ). Table 2 Journals of the Most Cited Papers on 4D Flow MRI Number of Times Cited Journal Journal Impact Factor (2020) 19 American Journal of Neuroradiology 3.825 5 Neuroradiology 2.804 3 Clinical Neuroradiology 3.649 2 Neuroradiology Journal 1.51 1 Plos One 3.24 One article from the top 30 most-cited list was excluded due to its focus on ADC MR imaging as opposed to 4D flow. The top three most cited journals were American Journal of Neuroradiology (AJNR) (19; Impact Factor (IF) 3.825), Neuroradiology (5; IF 2.804), and Clinical Neuroradiology (3; IF 3.649). The most published first-authors in this realm included Kazuya Futami of Japan (3 first authorships); Chi-Haur Wu of the U.S. (3 first authorships), Warren Chang of the U.S., and Haruo Isoda of Japan (2 first authorships each). The most cited articles were “In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T” by Wetzel et al. (2007) in AJNR (98 citations); “Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics by Isoda et al. (2010) in Neuroradiology (74 citations); “Intracranial 4D MRI: Toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes” by Ansari et al. (2013) in AJNR (63 citations); and “In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI” by Isoda et al. (2010) in Neuroradiology (55 citations). The most common principal pathologies addressed by the studies included cerebral arteriovenous malformations (8 articles), intracranial aneurysms (4 articles), cerebral aneurysms (3 articles), and cerebrovascular disease (2 articles) (Table 3 ). Table 3 Most Common Principal Pathology of the Top 30 Most Cited Papers on 4D Flow MRI Number of Articles Principle Pathology of Publication 8 Cerebral AVM 4 Intracranial Aneurysm 3 Cerebral Aneurysm 2 Cerebrovascular Disease 1 Internal Carotid Artery Stenosis 1 Carotid Siphon Hemodynamics 1 Carotid-Cavernous Fistula 1 Circle of Willis Hemodynamics 1 Dural Arteriovenous Fistula 1 Extracranial-Intracranial Bypass 1 Intracranial Arteriovenous Malformation 1 Intracranial Stenosis 1 Intracranial Stenosis, Aneurysms, & Arteriovenous Malformation 1 Parathyroid Adenoma 1 Posterior Circulation Occlusion 1 Primary Hyperparathyroidism 1 Steno-Occlusive Neurovascular Disease DISCUSSION We conducted a bibliometric review of the top 30 most-cited articles on 4D flow MRI to describe the demographics of these articles, provide a snapshot of the current state of literature on the topic, and highlight the emerging utility of 4D flow MRI in clinical practice along with potential uses. To the best our knowledge, this is the first study to trend research and analyze the impact of studies exploring the neurodiagnostic utility of 4D Flow MRI. Our findings will inform neuroradiologists regarding the purpose and uses of this technology and delineate areas for future investigation to optimize its incorporation into clinical practice. Measuring Blood Flow in the Brain Measuring blood flow in cerebral vasculature is essential for understanding the extent of brain disease and guiding treatment. Although these measurements may be obtained invasively through analysis of contrast agents, such as in cerebral angiography, noninvasive imaging is of lower risk and is generally preferred.[ 1 , 3 ] Computed tomography angiography may be used but involves a large radiation dose.[ 1 ] Transcranial Doppler (TCD) is often used to evaluate cerebral hemodynamics in real time due to its low cost and ease of transport but is subject to user and machine dependent variability.[ 3 ] For these reasons, TCD has been used to assess subarachnoid hemorrhage and cerebral vasospasm, intracranial steno-occlusive disease, acute ischemic stroke, collateral flow, sickle cell disease, cerebral circulatory arrest, and microemboli – but is somewhat limited in its assessment.[ 5 ] However, this technology is generally limited to 1D and 2D velocity measurements, and its precision depends on operator experience, equipment quality, and the use of specific bone windows to optimize signal to noise ratio.[ 6 , 7 ] 4D flow MRI represents an alternative to these more traditional modalities. Adopting 4D flow into MRI was met with early challenges, including low resolution, long scanning times, loss of signal due to complex flow, and difficulty selecting the appropriate velocity encoding sensitivity(VENC).[ 4 ] However, these limitations have been largely overcome by advances in hardware, notably 3T scanners and 32-channel coils that promote higher spatial resolution, and software, including compressed sensing and radial k-space trajectories to reduce acquisition time. Also new encoding strategies to broaden the range of velocities detected, shorter excitation times to reduce signal loss, regularization of vector field divergence during image reconstruction to improve reconstruction accuracy of velocity vector fields, and denoising strategies to improve spatial resolution and velocity fields have been helpful.[ 4 , 8 – 13 ] Owing to these improvements and the technology itself, current advantages of 4D flow MRI include high resolution, minimal user dependence in contrast to TCD, increased efficiency, derivation of multiple hemodynamic indices, and the ability to decide what and where to analyze at the post-processing stage rather than during the examination.[ 2 ] Moreover, the technology continues to evolve. Recently, accelerated dual-VENC 4D flow MRI sequence with k-t generalized auto-calibrating partially parallel acquisition acceleration was developed specifically for neurovascular applications.[ 14 ] This method improves flow visualization, image quality, and image noise through superior velocity to noise ratio and simultaneously incorporate low-velocity and high-velocity fields.[ 14 ] Recently, Triple VENC 4D flow MRI was shown to consistently outperform dual VENC MRI without adding scan time. 15 Most Influential Articles This bibliometric analysis identified the most influential articles on 4D flow MRI. Some articles provided proof-of-concept evidence for the utility of this technology in healthy volunteers and sought to characterize cerebral hemodynamics. The first most-cited article by Wetzel et al. demonstrated successful temporal and spatial evolution of blood flow, such as a helical flow pattern in the carotid sophon.[ 10 ] Other articles examined a variety of cerebrovascular pathologies, most commonly cerebral AVMs and intracranial aneurysms. The fourth most-cited article by Ansari et al. indicated the Spetzler-Martin grade was not associated with differences in 3D arterial and venous hemodynamics of the AVM. 16 The authors advocated for individualized assessment of AVMs and concluded that 4D flow MRI may allow for improved evaluation of AVM hemodynamics, monitoring during embolization, and improved treatment planning relative to utilizing the Spetzler-Martin grade alone.[ 15 ] The third and fifth most-cited articles, both by Isoda et al., examined intracranial aneurysms.[ 16 , 17 ] One used 4D flow MRI to determine wall shear stress was lower and oscillatory shear index was higher at the apex of spiral flow than the whole aneurysmal flow.[ 16 ] The other determined that MR fluid dynamics extracted from 4D flow MRI correlated with MR-based computational fluid dyanmics.[ 17 ] AVMs and aneurysms represent important areas of investigation for 4D flow MRI because the complex morphology and hemodynamics inherent in these pathologies prevent complete characterization through CT or TCD. 4D flow MRI may assist in characterization of the effect of AVMs on brain blood flow.[ 4 ] 4D flow may also improve characterization of intracranial aneurysms based on flow features and identify which flow features promote formation, growth, and rupture.[ 4 ] Moreover, 4D flow MRI may assist in risk stratification and assessment of treatment response.[ 18 ] Additionally, articles compared 4D flow MRI to other modalities, demonstrated that 4D flow MRI is an appropriate alternative in quantifying intracranial blood velocity to TCD.[ 19 , 20 ] The number of publications on 4D flow MRI increased over time, indicating increased research activity – and, potentially, greater clinical applicability. Future Directions The time resolved cine 3-D velocity acquisitions that is the essence of 4-D MRI is possible only because of the technical advances in data acquisition. Potential hemodynamic biomarkers like wall shear stress and pulse wave velocity have massive potential clinical utility. These can assess the hardness of vessel walls and may potentially be useful to assess response to vasculo-protective treatment. It is reiterated that the measurements will be more reliable than 2-D measurements because they are averaged over time and pulsating changes in velocity are not overly influential. Evaluating hemodynamic parameters will be a useful adjunct to vessel wall imaging in neuroradiology and neurology practice - adding a reliable functional component to vessel wall imaging. Limitations This study has limitations. Bibliometric reviews attempt to quantify the clinical impact of interventions indirectly through research as a proxy. However, citation counts only measure the usefulness of a given manuscript to authors of other papers.[ 21 ] Highly cited papers may not be influential in clinical practice.[ 21 ] Moreover, bibliometric analyses do not indicate why articles are cited. They cannot determine whether articles are cited because they report breakthroughs in technologies, represent an advance to clinical practice, set the foundation for other research, or other reasons.[ 21 ] Bibliometric reviews do not necessarily quantify the impact of time.[ 21 ] Manuscripts accumulate citations over time.[ 21 ] It is unsurprising that the most-cited articles in this study were over 10 years old, which may further misrepresent their influence. Bibliometric reviews do not critically appraise the quality of studies,[ 22 ] limiting the applicability of this study design to indicate whether articles are methodologically sound or provide a rigorous synthesis of existing evidence. Specific pathologies were not included in the search terms, perhaps failing to retrieve all relevant articles. However, studies focused on 4D flow MRI as it applies to neuroradiology are likely to have been retrieved with the existing search string. Additionally, WoS contains only a fraction of journals globally, with fewer journals than other databases such as Scopus and Ulrich’s extensive periodical directory.[ 23 , 24 ] This may have reduced our ability to retrieve all pertinent articles, though WoS is a common database utilized for the bibliometric study design. WoS is heavily biased towards English language journals despite increased representation of non-English journals over time,[ 24 , 25 ] perhaps leading us to conclude that an unrepresentative set of articles is the most-cited set. Additionally, the number of citations in WoS differs from that on other databases, as citations made in journals not listed on WoS do not affect the impact factor, perhaps inadvertently misrepresenting the scholarly impact of the included studies.[ 26 ] Nonetheless, this article represents a methodologically rigorous, reproducible investigation of the most cited articles on 4D flow MRI to highlight the current status of the technology in neuroradiology and characterize opportunities for future study. CONCLUSIONS 4D flow MRI represents an opportunity for improving the resolution and precision of cardiac and neurologic vascular radiologic imaging. 4D flow MRI has rapidly evolved from an experimental imaging modality to become incorporated into clinical practice as evidenced by marked clinical research activity in recent years. Future research and developments in understanding of the neuro-diagnostic utility of 4D Flow would likely improve diagnosis and treatment planning of neurologic and neurosurgical disorders, particularly those of cerebrovascular etiology. Declarations FINANCIAL DISCLOSURE: The authors did not receive funding for this work. CONFLICT OF INTEREST: The authors have no conflicts of interest to disclose. References Morgan AG et al (2021) 4D flow MRI for non-invasive measurement of blood flow in the brain: a systematic review. J Cereb Blood Flow Metabolism 41(2):206–218 Wåhlin A, Eklund A, Malm J (2022) 4D flow MRI hemodynamic biomarkers for cerebrovascular diseases. J Intern Med 291(2):115–127 Pereira VM et al (2016) 4D flow MRI in neuroradiology: techniques and applications. Top Magn Reson Imaging 25(2):81–87 Turski P, Edjlali M, Oppenheim C (2013) Fast 4D flow MRI re-emerges as a potential clinical tool for neuroradiology. Am J Neuroradiol 34(10):1929–1930 Purkayastha S, Sorond F (2012) Transcranial Doppler ultrasound: technique and application . in Seminars in neurology . Thieme Medical Evans DH, Jensen JA, Nielsen MB (2011) Ultrasonic colour Doppler imaging. Interface focus 1(4):490–502 Hoskins P (1996) Accuracy of maximum velocity estimates made using Doppler ultrasound systems. Br J Radiol 69(818):172–177 Stadlbauer A et al (2010) Accelerated time-resolved three-dimensional MR velocity mapping of blood flow patterns in the aorta using SENSE and kt BLAST. Eur J Radiol 75(1):e15–e21 Gu T et al (2005) PC VIPR: a high-speed 3D phase-contrast method for flow quantification and high-resolution angiography. Am J Neuroradiol 26(4):743–749 Wetzel S et al (2007) In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T. Am J Neuroradiol 28(3):433–438 Johnson KM, Markl M (2010) Improved SNR in phase contrast velocimetry with five-point balanced flow encoding. Magn Reson Medicine: Official J Int Soc Magn Reson Med 63(2):349–355 Callaghan FM, Grieve SM (2017) Spatial resolution and velocity field improvement of 4D-flow MRI. Magnetic resonance in medicine. 78(5):1959–1968 Santelli C et al (2016) Accelerating 4D flow MRI by exploiting vector field divergence regularization. Magn Reson Med 75(1):115–125 Schnell S et al (2017) Accelerated dual-venc 4D flow MRI for neurovascular applications. J Magn Reson Imaging 46(1):102–114 Ansari S et al (2013) Intracranial 4D flow MRI: toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes. Am J Neuroradiol 34(10):1922–1928 Isoda H et al (2010) In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI. Neuroradiology 52(10):921–928 Isoda H et al (2010) Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics. Neuroradiology 52(10):913–920 Schnell S, Wu C, Ansari SA (2016) 4D MRI flow examinations in cerebral and extracerebral vessels. Ready for clinical routine? Curr Opin Neurol 29(4):419 Harloff A et al (2013) Comparison of blood flow velocity quantification by 4D flow MR imaging with ultrasound at the carotid bifurcation. Am J Neuroradiol 34(7):1407–1413 Meckel S et al (2013) Intracranial artery velocity measurement using 4D PC MRI at 3 T: comparison with transcranial ultrasound techniques and 2D PC MRI. Neuroradiology 55(4):389–398 Belter CW (2015) Bibliometric indicators: opportunities and limits. J Med Libr Association: JMLA 103(4):219 Haustein S, Larivière V (2015) The use of bibliometrics for assessing research: Possibilities, limitations and adverse effects , in Incentives and performance . Springer, pp 121–139 Singh VK et al (2021) The journal coverage of Web of Science, Scopus and Dimensions: A comparative analysis. Scientometrics 126(6):5113–5142 Mongeon P, Paul-Hus A (2016) The journal coverage of Web of Science and Scopus: a comparative analysis. Scientometrics 106(1):213–228 Vera-Baceta M-A, Thelwall M, Kousha K (2019) Web of Science and Scopus language coverage. Scientometrics 121(3):1803–1813 Kurmis AP (2003) Understanding the limitations of the journal impact factor. JBJS 85(12):2449–2454 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5392070","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":374149824,"identity":"e0959018-d332-44a3-83b8-22bb68e89e45","order_by":0,"name":"Jamie E. Clarke, M.D., M.S.","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIie3OMWrDMBSA4ScCneRmdXDrXEFBEAq+jI1BWQzt6CFQFYOz+ACGDD1EoVMHGYGzeC4BLfXSKUOm0kIIjZVOBYmOHfQPD6SnDwTgcv3DEAckAGIYnw7++W7Eh2EjoMmEa0J+7ixkSBMi/kpGq+JNfL2wkL7KRt3lByCb5mEPeZRw08eqljTVe0bniqVR3REgXVL40C3MpM5AYJEnzyqbB155IlvEfVRKM3ncQXMQ+f3T+vYj8I6aFJ/oaCE1BolFFpMguwg8rknpI24hFSPySrBZrRiNcEvxpEvKm7hdUBOZrWTf70Q6Ha/TXuFlGF5upNzul9G1kfxeYD1jw/OhqWXncrlcrnPfQXleozsPpO8AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-6422-5629","institution":"University of California, Los Angeles","correspondingAuthor":true,"prefix":"","firstName":"M.D.","middleName":"Jamie E.","lastName":"Clarke","suffix":"M.D."}],"badges":[],"createdAt":"2024-11-05 04:35:36","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-5392070/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5392070/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":68342984,"identity":"892abdb5-36d9-41ec-92ba-c428855542d6","added_by":"auto","created_at":"2024-11-06 09:12:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":578305,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5392070/v1/dac0bd03-4acc-4af5-94ad-6214fb948c0f.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eEvolution of 4D Flow MRI Utility in Neuroradiology: A Bibliometric Analysis\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCerebrovascular atherosclerosis may result in cerebrovascular disease such as stroke, small vessel disease, and/or vascular dementia, while microvascular damage and arterial wall remodeling may be implicated in neurodegenerative diseases.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Examination of blood flow in the cerebral vasculature yields signs of early disease and characterizes the extent of damage in advanced cases.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Quantitative measurements of blood flow in cerebral arteries and veins may allow investigators to better understand and treat cerebrovascular disease.\u003c/p\u003e \u003cp\u003eMagnetic resonance imaging (MRI) is an essential tool for evaluating morphology and function in patients with diseases of the intracranial vasculature. Phase-contrast MRI, which is generally acquired in two spatial dimensions and one temporal dimension correcting for the cardiac phase, can measure fluid velocity in major blood vessels.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] An advanced phase-contrast MRI technique known as 4D phase-contrast MRI or 4D flow MRI was created to allow quantitative in vivo 3D flow assessment by capturing velocities in the three cardinal directions.[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Despite early challenges, this modality has enjoyed increased interest in recent years.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAs the benefits of 4D flow MRI are getting increasingly established, its use in normal and pathological states has increased in research and clinical practice. Given the emerging role of 4D MRI in neuroradiology, we investigated the 30 most-cited publications on the topic in the English-language literature to compile demographics of these studies, examine common pathologies and topics, and present existing and emerging uses of 4D flow MRI in clinical neuroradiological practice. This study will increase understanding of the role of this technology among neuroradiologists and promote further research to maximize the clinical utility of 4D flow MRI.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA bibliometric analysis was performed on September 13, 2021. A title-specific word search with the term \u0026ldquo;4D MRI Neuroradiology\u0026rdquo; was conducted using the Web of Science (WoS) database to identify the most influential research publications on 4D MRI. The search yielded 231 total articles. Articles were then sorted in descending order by number of citations. The articles ranked 1\u0026ndash;30 were included in the analysis. Bibliometric and demographic variables were extracted from each WoS article. These included publication title, publication first author, number of authors, number of citations, year of publication, journal, journal impact factor (2020), WoS categories, decade of publication, country of first author, United States (US) region of first author for papers written by US authors, and pathology examined. IBM SPSS Version 26 (SPSS Inc., Chicago, IL) was used to perform analyses of frequencies, sums, and means.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf 231 articles retrieved in the search, total of 30 articles with 3 to 98 citations were included in this analysis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTop 30 Most Cited Papers on 4D Flow MRI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMost Cited Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTitle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFirst Author\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTotal Citations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWeb of Science Categories\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWetzel, Sandrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIsoda, Haruo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntracranial 4D flow MRI: Toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAnsari, Sameer A.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIsoda, Haruo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComparison of blood flow velocity quantification by 4D flow MR imaging with ultrasound at the carotid bifurcation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHarloff, Andreas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eComplete intracranial arterial and venous blood flow evaluation with 4D flow MR imaging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHope, Michael\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntracranial artery velocity measurement using 4D PC MRI at 3 T: comparison with trans cranial ultrasound techniques and 2D PC MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMeckel, Stephan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDampening of blood-flow pulsatility along the carotid siphon: Does form follow function?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSchubert, Tilman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMagnetic particle imaging for high temporal resolution assessment of aneurysm hemodynamics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePlos One\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSedlacik, Jan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eScience \u0026amp; Technology - Other Topics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDynamic 4D MRI for characterization of parathyroid adenomas: Multiparametric analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNael, Kambiz\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluation of 4D vascular flow and tissue perfusion in cerebral arteriovenous malformations: Influence of Spetzler-Martin grade, clinical presentation, and AVM risk factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWu, Chi-Haur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFast contrast-enhanced 4D MRA and 4D flow MRI using constrained reconstruction (HYPERFlow): Potential applications for brain arteriovenous malformations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChang, Warren\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4D flow MRI assessment of extracranial-intracranial bypass: qualitative and quantitative evaluation of the hemodynamics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSekine, Tetsuro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdentification of inflow zone of unruptured cerebral aneurysms: comparison of 4D flow MRI and 3D TOF MRA data\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFutami, Kazuya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIn vivo assessment of the impact of regional intracranial atherosclerotic lesions on brain arterial 3D hemodynamics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWu, Chi-Haur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePressure mapping and hemodynamic assessment of intracranial dural sinuses and dural arteriovenous fistulas with 4D flow MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRivera-Rivera, Leonardo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEarly hemodynamic response assessment of stereotactic radiosurgery for a cerebral arteriovenous malformation using 4D flow MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLi, Charles Q.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmerging techniques for evaluation of the hemodynamics of intracranial vascular pathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuroradiology Journal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChang, Warren\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeuroimaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFLAIR vascular hyperintensities and dynamic 4D angiograms for the estimation of collateral blood flow in posterior circulation occlusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eForester, Alex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInflow jet patterns of unruptured cerebral aneurysms based on the flow velocity in the parent artery: Evaluation using 4D flow MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFutami, Kazuya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFast 4D flow MRI re-emerges as a potential clinical tool for neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTurski, Patrick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow flow reduction influences the intracranial aneurysm occlusion: A prospective 4D phase-contrast MRI study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBrina, Olivier\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLarge neck and strong ostium inflow as the potential causes for delayed occlusion of unruptured sidewall intracranial aneurysms treated by flow diverter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSu, Tianhao\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOptimization of the surgical approach in AVMs using MRI and 4D DSA Fusion Technique\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTrite, Stephanie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4D dynamic contrast-enhanced MRI for preoperative localization in patients with primary hyperparathyroidism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBecker, Jennifer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIdentification of vortex cores in cerebral aneurysms on 4D flow MRI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFutami, Kazuya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFollow-up MRI for small brain AVMs treated by radiosurgery: Is gadolinium really necessary?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLeclerc, Xavier\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Neuroimaging; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCombined DSA and 4D flow demonstrate overt alterations of vascular geometry and hemodynamics in an unusually complex cerebral AVM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWu, Chi-Haur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeasibility of noninvasive diagnosis and treatment planning in a case series with carotid-cavernous fistula using high-resolution time-resolved MR-angiography with stochastic trajectories (TWIST) and extended parallel acquisition technique (ePAT 6) at 3 T\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSeeger, Achim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClinical Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh spatiotemporal resolution 4D flow MRI of intracranial aneurysms at 7T in 10 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGottwald, Lukas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNeurosciences \u0026amp; Neurology; Radiology, Nuclear Medicine \u0026amp; Medical Imaging\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll articles were published between 2007 and 2020. Articles were published across five unique journals (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eJournals of the Most Cited Papers on 4D Flow MRI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Times Cited\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJournal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJournal Impact Factor (2020)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAmerican Journal of Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.825\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.804\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical Neuroradiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.649\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuroradiology Journal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlos One\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOne article from the top 30 most-cited list was excluded due to its focus on ADC MR imaging as opposed to 4D flow. The top three most cited journals were \u003cem\u003eAmerican Journal of Neuroradiology (AJNR)\u003c/em\u003e (19; Impact Factor (IF) 3.825), \u003cem\u003eNeuroradiology\u003c/em\u003e (5; IF 2.804), and \u003cem\u003eClinical Neuroradiology\u003c/em\u003e (3; IF 3.649). The most published first-authors in this realm included Kazuya Futami of Japan (3 first authorships); Chi-Haur Wu of the U.S. (3 first authorships), Warren Chang of the U.S., and Haruo Isoda of Japan (2 first authorships each).\u003c/p\u003e \u003cp\u003eThe most cited articles were \u0026ldquo;In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T\u0026rdquo; by Wetzel et al. (2007) in \u003cem\u003eAJNR\u003c/em\u003e (98 citations); \u0026ldquo;Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics by Isoda et al. (2010) in \u003cem\u003eNeuroradiology\u003c/em\u003e (74 citations); \u0026ldquo;Intracranial 4D MRI: Toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes\u0026rdquo; by Ansari et al. (2013) in \u003cem\u003eAJNR\u003c/em\u003e (63 citations); and \u0026ldquo;In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI\u0026rdquo; by Isoda et al. (2010) in \u003cem\u003eNeuroradiology\u003c/em\u003e (55 citations).\u003c/p\u003e \u003cp\u003eThe most common principal pathologies addressed by the studies included cerebral arteriovenous malformations (8 articles), intracranial aneurysms (4 articles), cerebral aneurysms (3 articles), and cerebrovascular disease (2 articles) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMost Common Principal Pathology of the Top 30 Most Cited Papers on 4D Flow MRI\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Articles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrinciple Pathology of Publication\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebral AVM\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntracranial Aneurysm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebral Aneurysm\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCerebrovascular Disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal Carotid Artery Stenosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarotid Siphon Hemodynamics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCarotid-Cavernous Fistula\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCircle of Willis Hemodynamics\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDural Arteriovenous Fistula\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtracranial-Intracranial Bypass\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntracranial Arteriovenous Malformation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntracranial Stenosis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntracranial Stenosis, Aneurysms, \u0026amp; Arteriovenous Malformation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParathyroid Adenoma\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior Circulation Occlusion\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Hyperparathyroidism\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSteno-Occlusive Neurovascular Disease\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWe conducted a bibliometric review of the top 30 most-cited articles on 4D flow MRI to describe the demographics of these articles, provide a snapshot of the current state of literature on the topic, and highlight the emerging utility of 4D flow MRI in clinical practice along with potential uses. To the best our knowledge, this is the first study to trend research and analyze the impact of studies exploring the neurodiagnostic utility of 4D Flow MRI. Our findings will inform neuroradiologists regarding the purpose and uses of this technology and delineate areas for future investigation to optimize its incorporation into clinical practice.\u003c/p\u003e\n\u003ch3\u003eMeasuring Blood Flow in the Brain\u003c/h3\u003e\n\u003cp\u003eMeasuring blood flow in cerebral vasculature is essential for understanding the extent of brain disease and guiding treatment. Although these measurements may be obtained invasively through analysis of contrast agents, such as in cerebral angiography, noninvasive imaging is of lower risk and is generally preferred.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Computed tomography angiography may be used but involves a large radiation dose.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Transcranial Doppler (TCD) is often used to evaluate cerebral hemodynamics in real time due to its low cost and ease of transport but is subject to user and machine dependent variability.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] For these reasons, TCD has been used to assess subarachnoid hemorrhage and cerebral vasospasm, intracranial steno-occlusive disease, acute ischemic stroke, collateral flow, sickle cell disease, cerebral circulatory arrest, and microemboli \u0026ndash; but is somewhat limited in its assessment.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] However, this technology is generally limited to 1D and 2D velocity measurements, and its precision depends on operator experience, equipment quality, and the use of specific bone windows to optimize signal to noise ratio.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] 4D flow MRI represents an alternative to these more traditional modalities. Adopting 4D flow into MRI was met with early challenges, including low resolution, long scanning times, loss of signal due to complex flow, and difficulty selecting the appropriate velocity encoding sensitivity(VENC).[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] However, these limitations have been largely overcome by advances in hardware, notably 3T scanners and 32-channel coils that promote higher spatial resolution, and software, including compressed sensing and radial k-space trajectories to reduce acquisition time. Also new encoding strategies to broaden the range of velocities detected, shorter excitation times to reduce signal loss, regularization of vector field divergence during image reconstruction to improve reconstruction accuracy of velocity vector fields, and denoising strategies to improve spatial resolution and velocity fields have been helpful.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Owing to these improvements and the technology itself, current advantages of 4D flow MRI include high resolution, minimal user dependence in contrast to TCD, increased efficiency, derivation of multiple hemodynamic indices, and the ability to decide what and where to analyze at the post-processing stage rather than during the examination.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] Moreover, the technology continues to evolve. Recently, accelerated dual-VENC 4D flow MRI sequence with k-t generalized auto-calibrating partially parallel acquisition acceleration was developed specifically for neurovascular applications.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] This method improves flow visualization, image quality, and image noise through superior velocity to noise ratio and simultaneously incorporate low-velocity and high-velocity fields.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Recently, Triple VENC 4D flow MRI was shown to consistently outperform dual VENC MRI without adding scan time.\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eMost Influential Articles\u003c/h3\u003e\n\u003cp\u003eThis bibliometric analysis identified the most influential articles on 4D flow MRI. Some articles provided proof-of-concept evidence for the utility of this technology in healthy volunteers and sought to characterize cerebral hemodynamics. The first most-cited article by Wetzel et al. demonstrated successful temporal and spatial evolution of blood flow, such as a helical flow pattern in the carotid sophon.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Other articles examined a variety of cerebrovascular pathologies, most commonly cerebral AVMs and intracranial aneurysms. The fourth most-cited article by Ansari et al. indicated the Spetzler-Martin grade was not associated with differences in 3D arterial and venous hemodynamics of the AVM.\u003csup\u003e16\u003c/sup\u003e The authors advocated for individualized assessment of AVMs and concluded that 4D flow MRI may allow for improved evaluation of AVM hemodynamics, monitoring during embolization, and improved treatment planning relative to utilizing the Spetzler-Martin grade alone.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] The third and fifth most-cited articles, both by Isoda et al., examined intracranial aneurysms.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] One used 4D flow MRI to determine wall shear stress was lower and oscillatory shear index was higher at the apex of spiral flow than the whole aneurysmal flow.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] The other determined that MR fluid dynamics extracted from 4D flow MRI correlated with MR-based computational fluid dyanmics.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] AVMs and aneurysms represent important areas of investigation for 4D flow MRI because the complex morphology and hemodynamics inherent in these pathologies prevent complete characterization through CT or TCD. 4D flow MRI may assist in characterization of the effect of AVMs on brain blood flow.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] 4D flow may also improve characterization of intracranial aneurysms based on flow features and identify which flow features promote formation, growth, and rupture.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Moreover, 4D flow MRI may assist in risk stratification and assessment of treatment response.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Additionally, articles compared 4D flow MRI to other modalities, demonstrated that 4D flow MRI is an appropriate alternative in quantifying intracranial blood velocity to TCD.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] The number of publications on 4D flow MRI increased over time, indicating increased research activity \u0026ndash; and, potentially, greater clinical applicability.\u003c/p\u003e\n\u003ch3\u003eFuture Directions\u003c/h3\u003e\n\u003cp\u003eThe time resolved cine 3-D velocity acquisitions that is the essence of 4-D MRI is possible only because of the technical advances in data acquisition. Potential hemodynamic biomarkers like wall shear stress and pulse wave velocity have massive potential clinical utility. These can assess the hardness of vessel walls and may potentially be useful to assess response to vasculo-protective treatment. It is reiterated that the measurements will be more reliable than 2-D measurements because they are averaged over time and pulsating changes in velocity are not overly influential. Evaluating hemodynamic parameters will be a useful adjunct to vessel wall imaging in neuroradiology and neurology practice - adding a reliable functional component to vessel wall imaging.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has limitations. Bibliometric reviews attempt to quantify the clinical impact of interventions indirectly through research as a proxy. However, citation counts only measure the usefulness of a given manuscript to authors of other papers.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Highly cited papers may not be influential in clinical practice.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Moreover, bibliometric analyses do not indicate why articles are cited. They cannot determine whether articles are cited because they report breakthroughs in technologies, represent an advance to clinical practice, set the foundation for other research, or other reasons.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Bibliometric reviews do not necessarily quantify the impact of time.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] Manuscripts accumulate citations over time.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] It is unsurprising that the most-cited articles in this study were over 10 years old, which may further misrepresent their influence. Bibliometric reviews do not critically appraise the quality of studies,[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] limiting the applicability of this study design to indicate whether articles are methodologically sound or provide a rigorous synthesis of existing evidence. Specific pathologies were not included in the search terms, perhaps failing to retrieve all relevant articles. However, studies focused on 4D flow MRI as it applies to neuroradiology are likely to have been retrieved with the existing search string. Additionally, WoS contains only a fraction of journals globally, with fewer journals than other databases such as Scopus and Ulrich\u0026rsquo;s extensive periodical directory.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] This may have reduced our ability to retrieve all pertinent articles, though WoS is a common database utilized for the bibliometric study design. WoS is heavily biased towards English language journals despite increased representation of non-English journals over time,[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] perhaps leading us to conclude that an unrepresentative set of articles is the most-cited set. Additionally, the number of citations in WoS differs from that on other databases, as citations made in journals not listed on WoS do not affect the impact factor, perhaps inadvertently misrepresenting the scholarly impact of the included studies.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] Nonetheless, this article represents a methodologically rigorous, reproducible investigation of the most cited articles on 4D flow MRI to highlight the current status of the technology in neuroradiology and characterize opportunities for future study.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003e4D flow MRI represents an opportunity for improving the resolution and precision of cardiac and neurologic vascular radiologic imaging. 4D flow MRI has rapidly evolved from an experimental imaging modality to become incorporated into clinical practice as evidenced by marked clinical research activity in recent years. Future research and developments in understanding of the neuro-diagnostic utility of 4D Flow would likely improve diagnosis and treatment planning of neurologic and neurosurgical disorders, particularly those of cerebrovascular etiology.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFINANCIAL DISCLOSURE:\u0026nbsp;\u003c/strong\u003eThe authors did not receive funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTEREST:\u0026nbsp;\u003c/strong\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMorgan AG et al (2021) 4D flow MRI for non-invasive measurement of blood flow in the brain: a systematic review. J Cereb Blood Flow Metabolism 41(2):206\u0026ndash;218\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eW\u0026aring;hlin A, Eklund A, Malm J (2022) 4D flow MRI hemodynamic biomarkers for cerebrovascular diseases. J Intern Med 291(2):115\u0026ndash;127\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira VM et al (2016) 4D flow MRI in neuroradiology: techniques and applications. Top Magn Reson Imaging 25(2):81\u0026ndash;87\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurski P, Edjlali M, Oppenheim C (2013) Fast 4D flow MRI re-emerges as a potential clinical tool for neuroradiology. Am J Neuroradiol 34(10):1929\u0026ndash;1930\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePurkayastha S, Sorond F (2012) \u003cem\u003eTranscranial Doppler ultrasound: technique and application\u003c/em\u003e. in \u003cem\u003eSeminars in neurology\u003c/em\u003e. Thieme Medical\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvans DH, Jensen JA, Nielsen MB (2011) Ultrasonic colour Doppler imaging. Interface focus 1(4):490\u0026ndash;502\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoskins P (1996) Accuracy of maximum velocity estimates made using Doppler ultrasound systems. Br J Radiol 69(818):172\u0026ndash;177\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStadlbauer A et al (2010) Accelerated time-resolved three-dimensional MR velocity mapping of blood flow patterns in the aorta using SENSE and kt BLAST. Eur J Radiol 75(1):e15\u0026ndash;e21\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu T et al (2005) PC VIPR: a high-speed 3D phase-contrast method for flow quantification and high-resolution angiography. Am J Neuroradiol 26(4):743\u0026ndash;749\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWetzel S et al (2007) In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T. Am J Neuroradiol 28(3):433\u0026ndash;438\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson KM, Markl M (2010) Improved SNR in phase contrast velocimetry with five-point balanced flow encoding. Magn Reson Medicine: Official J Int Soc Magn Reson Med 63(2):349\u0026ndash;355\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCallaghan FM, Grieve SM (2017) \u003cem\u003eSpatial resolution and velocity field improvement of 4D-flow MRI.\u003c/em\u003e Magnetic resonance in medicine. 78(5):1959\u0026ndash;1968\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantelli C et al (2016) Accelerating 4D flow MRI by exploiting vector field divergence regularization. Magn Reson Med 75(1):115\u0026ndash;125\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchnell S et al (2017) Accelerated dual-venc 4D flow MRI for neurovascular applications. J Magn Reson Imaging 46(1):102\u0026ndash;114\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnsari S et al (2013) Intracranial 4D flow MRI: toward individualized assessment of arteriovenous malformation hemodynamics and treatment-induced changes. Am J Neuroradiol 34(10):1922\u0026ndash;1928\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsoda H et al (2010) In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI. Neuroradiology 52(10):921\u0026ndash;928\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsoda H et al (2010) Comparison of hemodynamics of intracranial aneurysms between MR fluid dynamics using 3D cine phase-contrast MRI and MR-based computational fluid dynamics. Neuroradiology 52(10):913\u0026ndash;920\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchnell S, Wu C, Ansari SA (2016) 4D MRI flow examinations in cerebral and extracerebral vessels. Ready for clinical routine? Curr Opin Neurol 29(4):419\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarloff A et al (2013) Comparison of blood flow velocity quantification by 4D flow MR imaging with ultrasound at the carotid bifurcation. Am J Neuroradiol 34(7):1407\u0026ndash;1413\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeckel S et al (2013) Intracranial artery velocity measurement using 4D PC MRI at 3 T: comparison with transcranial ultrasound techniques and 2D PC MRI. Neuroradiology 55(4):389\u0026ndash;398\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBelter CW (2015) Bibliometric indicators: opportunities and limits. J Med Libr Association: JMLA 103(4):219\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaustein S, Larivi\u0026egrave;re V (2015) \u003cem\u003eThe use of bibliometrics for assessing research: Possibilities, limitations and adverse effects\u003c/em\u003e, in \u003cem\u003eIncentives and performance\u003c/em\u003e. Springer, pp 121\u0026ndash;139\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh VK et al (2021) The journal coverage of Web of Science, Scopus and Dimensions: A comparative analysis. Scientometrics 126(6):5113\u0026ndash;5142\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMongeon P, Paul-Hus A (2016) The journal coverage of Web of Science and Scopus: a comparative analysis. Scientometrics 106(1):213\u0026ndash;228\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVera-Baceta M-A, Thelwall M, Kousha K (2019) Web of Science and Scopus language coverage. Scientometrics 121(3):1803\u0026ndash;1813\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKurmis AP (2003) Understanding the limitations of the journal impact factor. JBJS 85(12):2449\u0026ndash;2454\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of California, Los Angeles","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"4D Flow MRI, Neuroradiology, Neurosurgery, Diagnostic Radiology","lastPublishedDoi":"10.21203/rs.3.rs-5392070/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5392070/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTo our knowledge, this is the first study to trend research and analyze the impact of studies exploring the neurodiagnostic utility of 4D Flow MRI. A bibliometric analysis was performed in Web of Science on September 13, 2021 using search term \u0026ldquo;4D MRI Neuroradiology\u0026rdquo; to identify and assess the 30 most-cited 4D Flow MRI neuroimaging publications in the literature from 2000\u0026ndash;2021. The 30 most-cited articles ranged from 3 to 98 citations across 8 unique journals. The articles were published between 2007 to 2020. The top three most cited journals were \u003cem\u003eAmerican Journal of Neuroradiology (AJNR)\u003c/em\u003e (Impact Factor (IF) 3.825), \u003cem\u003eNeuroradiology\u003c/em\u003e (IF 2.804), and \u003cem\u003eClinical Neuroradiology\u003c/em\u003e (IF 3.649). The most cited article was from 2007 by Wetzel et al. in \u003cem\u003eAJNR\u003c/em\u003e: \u0026ldquo;In vivo assessment and visualization of intracranial arterial hemodynamics with flow-sensitized 4D MR imaging at 3T.\u0026rdquo; The most published first-authors in this realm included Kazuya Futami of Japan (3 first authorships), Chi-Haur Wu of the U.S. (3 first authorships), Warren Chang of the U.S., and Haruo Isoda of Japan (2 first authorships each). The most common principal pathologies addressed by the studies included cerebral arteriovenous malformations (8 articles), intracranial aneurysms (4 articles), cerebral aneurysms (3 articles), and cerebrovascular disease (2 articles). 4D flow MRI has rapidly evolved into a mainstay technology utilized for cardiac and neurologic vascular radiologic imaging. Future research in understanding of the neurodiagnostic utility of 4D Flow would improve diagnosis and treatment planning of neurologic and neurosurgical disorders, particularly those of cerebrovascular etiology.\u003c/p\u003e","manuscriptTitle":"Evolution of 4D Flow MRI Utility in Neuroradiology: A Bibliometric Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 09:04:21","doi":"10.21203/rs.3.rs-5392070/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ec6f889-5b7f-4911-b146-bbb3c190ef71","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":39822477,"name":"Neurology"}],"tags":[],"updatedAt":"2024-11-06T09:04:21+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-06 09:04:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5392070","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5392070","identity":"rs-5392070","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}