Illinois Abstract Purpose of review-To evaluate the feasibility of 4D flow MRI for the clinical assessment of cerebral and extracerebral vascular hemodynamics in patients with neurovascular disease. Recent findings-4D flow MRI has been applied in multiple studies to qualitatively and quantitatively study intracranial aneurysm blood flow for potential risk stratification and to assess treatment efficacy of various neurovascular lesions, including intra-aneurysmal and parent artery blood flow

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... r flow diverter stent placement and staged embolizations of arteriovenous malformations and vein of Galen aneurysmal malformations. Recently, the technique has been utilized to characterize age-related changes of normal cerebral hemodynamics in healthy subjects over a broad age range. Summary-4D flow MRI is a useful tool for the non-invasive, volumetric and quantitative hemodynamic assessment of neurovascular disease without the need for gadolinium contrast agents. Further improvements are warranted to overcome technical limitations before broader clinical implementation. Current developments, such as advanced acceleration techniques (parallel imaging and compressed sensing) for faster data acquisition, dual or multiple velocity encoding strategies for more accurate arterial and venous flow quantification, ultra-high field strengths to achieve higher spatial resolution, and streamlined post-processing workflow for more efficient and standardized flow analysis, are promising advancements in 4D flow MRI.