This book constitutes the refereed proceedings of the 4th International Workshop on Machine Learning for Medical Reconstruction, MLMIR 2021, held in conjunction with MICCAI 2021, in October 2021. The workshop was planned to take place in Strasbourg, France, but was held virtually due to the COVID-19 pandemic. The 13 papers presented were carefully reviewed and selected from 20 submissions. The papers are organized in the following topical sections: deep learning for magnetic resonance imaging and deep learning for general image reconstruction.