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Relative differences were increased for KE, typically on the order of 30%, with poor interobserver correlation between measurements. Four-dimensional flow MRI can quantify increases in flow in the AAo and MPA during strenuous exercise and is highly repeatable. KE had reduced repeatability because of suboptimal segmentation methods and requires further development before clinical implementation. © RSNA, 2020See also the commentary by Markl and Lee in this issue. Four-dimensional flow MRI can quantify increases in flow in the AAo and MPA