BR1: a new ultrasonographic contrast agent based on sulfur hexafluoride-filled microbubbles

Optical imaging of contrast agent microbubbles in an ultrasound field with a 100-MHz camera

Ultrasound (US) contrast agents, used in the field of medical diagnosis, contain small microbubbles of a mean diameter of about 3 microm. The acoustic behavior of these bubbles in US field has been subject to many investigations. In this study, we propose a method to visualize the behavior of the bubbles in a 0.5-MHz US field under a microscope with a frame rate of 4 MHz. For low acoustic pressures (peak negative pressure of 0.12 MPa), the radius-time curve as measured from the optical images is in agreement with the theory. For higher acoustic pressures (peak negative pressure of 0.6 MPa), the recorded radius is significantly larger than predicted by theory and sudden change in the bubbles shapes has been noticed. The proposed method enables the study and characterization of individual bubbles and their encapsulation. It is expected that this will open new areas for quality control, US contrast imaging and US-guided drug delivery.

Infusion versus bolus of an ultrasound contrast agent: in vivo dose-response measurements of BR1

RATIONALE AND OBJECTIVES

To determine the efficacy of an ultrasound contrast agent infusion using Doppler intensitometry estimation of backscatter enhancement in blood.

METHODS

Multiple intravenous injections of BR1 (SonoVue) were performed in chronic dog studies, using bolus (0.05-2 mL) and infusion (3-40 mL/h during 6 minutes) administration. The pulsed Doppler signal from the femoral artery was recorded and analyzed for mean Doppler power and integrated fractional enhancement.

RESULTS

For bolus injection, time-intensity curves exhibited a rapid first pass (peak 30 dB for 0.45 mL) followed by a slower washout. Integrated fractional enhancement exhibited a linear relation with the dose (R2 = 0.99). For infusion administration, peak enhancement increased with the infusion rate from 8 to 22 dB. At rates exceeding 30 mL/h, the enhancement was stable with a plateau-like pattern.

CONCLUSIONS

Infusion of BR1 is easily achieved and allows the duration of enhancement to be increased as long as desired. Stable enhancement is obtained for rates greater than 30 mL/h.

Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging

RATIONALE AND OBJECTIVES

To assess in humans the pharmacokinetics of SonoVue, a new echo contrast agent based on stabilized sulfur hexafluoride (SF6) microbubbles and to provide additional safety and tolerability information on the compound.

METHODS

The blood kinetics and pulmonary elimination of SF6 after intravenous bolus injection of two dosage levels (0.03 and 0.3 mL/kg) of SonoVue were evaluated in 12 healthy subjects (7 men, 5 women). In addition, safety and tolerability were evaluated by monitoring vital signs, adverse effects, discomfort, and physical examination and laboratory parameters associated with the SonoVue injection.

RESULTS

The blood kinetics of SF6 was not dose dependent. SF6 was rapidly removed from the blood by the pulmonary route, with 40% to 50% of the injected dose eliminated within the first minute after administration and 80% to 90% eliminated by 11 minutes after administration; the elimination was similar in men and women and independent of dose. Both dosages were well tolerated. No adverse effects were observed immediately or during the 24-hour follow-up period.

CONCLUSIONS

SonoVue was shown to be rapidly removed from the blood. The route of SF6 elimination was by means of the lungs in the expired air. SonoVue appeared to be safe and well tolerated in healthy subjects.

Characteristics of SonoVuetrade mark

The advances made by ultrasonography in the last decade, in parallel with the development of ultrasound contrast agents, have opened a wide range of potential breakthroughs in the field of ultrasound imaging. SonoVue(trade mark) is a new echocontrast agent made of microbubbles stabilized by phospholipids and containing sulphur hexafluoride (SF6), an innocuous gas. The suspension of the microbubbles is stable over the time following reconstitution. The bubble concentration of SonoVue(trade mark) is between 100 and 500 million per ml. The mean bubble diameter is 2.5 µm and more than 90% of the bubbles are smaller than 8 µm. Following intravenous injection, the bubble suspension is submitted to pressure increases. SF(6), a high molecular weight gas with low solubility in water, was selected since laboratory tests showed that it confers to the bubbles a good resistance to pressure changes as those that occur in the left ventricle, in the pulmonary capillaries, or in the coronary circulation. The high bubble concentration, combined with a favorable size distribution profile, provides SonoVue(trade mark) with a strong echogenicity. SonoVue(trade mark) shows a peak in the backscatter coefficient at about 3 MHz. With regard to the gas contained in the bubbles, its pharmacokinetics have been assessed during a study in human volunteers. Following intravenous administration of 0.3 ml/kg of SonoVue(trade mark) (i.e., approximately ten times the imaging dose), the blood level curve showed a distribution half-life of about 1 minute and an elimination half-life of about 6 minutes. More than 80% of the administered gas is exhaled via the lungs after 11 minutes. Extensive studies in animals and humans have confirmed the outstanding safety profile of this second generation contrast agent and its capability in providing a clinically useful ultrasound signal enhancement for the evaluation of cardiac function and extracardiac vessel abnormalities. Thanks to the long persistence of SF(6) microbubbles, SonoVue(trade mark) is also potentially useful in the assessment of myocardial perfusion, as well as microcirculatory disorders.

Safety and ultrasound-enhancing potentials of a new sulfur hexafluoride-containing agent in the cerebral circulation

Insufficient ultrasound penetration through the temporal bone is a serious limitation of transcranial ultrasound diagnostics. In a phase I study, the authors studied safety and ultrasound enhancing potentials of the new transpulmonary ultrasound contrast agent SonoVue, which contains sulfur hexafluoride gas microbubbles stabilized by a phospholipid shell. Twelve healthy volunteers received four different doses of SonoVue (0.3 ml, 0.6 ml, 1.2 ml, and 2.4 ml) intravenously. The duration of ultrasound contrast enhancement was measured by transcranial Doppler sonography (TCD) and transcranial color-coded sonography (TCCS). Safety and tolerability was monitored during the study and for 24 hours after contrast agent administration. TCD: Duration of spectral enhancement (signal intensity of 5 dB over baseline) was observed dose-related (p < 0.0001; Friedman-test) for (0.3 ml) 136 +/- 63.4 seconds; (0.6 ml) 191 +/- 63.3 seconds; (1.2 ml) 314 +/- 88 seconds; (2.4 ml) 434 +/- 168 seconds [mean +/- SD]. Dependent on dosage, the peak signal amplification in TCD was significantly different (p < 0.001; Friedman-test) as well: (0.3 ml) 24.5 +/- 2.0 dB; (0.6 ml) 26.0 +/- 1.6 dB; (1.2 ml) 27.6 +/- 2.2 dB; (2.4 ml) 28.4 +/- 2.2 dB (mean +/- SD). TCCS: Mean time of optimal enhancement increased from 214 +/- 73 seconds (0.3 ml) to 356 +/- 14 seconds (2.4 ml) in a dose-dependent manner. In TCCS, signal amplification appeared to be stronger with increasing doses. Adverse events were not observed during the study. This investigation describes the ultrasound enhancing potential of SonoVue in the intracranial cerebral circulation. SonoVue proved to be well tolerated and provided a long-lasting ultrasound contrast enhancement that supports an optimal transcranial ultrasound diagnostic.

The influence of Doppler system settings on the clearance kinetics of different ultrasound contrast agents

OBJECTIVE

To evaluate the influence of different Doppler system settings on time-intensity curves after ultrasound contrast agent (UCA) bolus injection. This is important for the comparison of different UCAs.

METHODS

Six sedated dogs were investigated with a transcranial Doppler system and Doppler power, sample volume size and high pass filter settings were modified during the procedure. Mean time intensity curves were determined and peak values of mean intensity as well as the decrease in Doppler intensity were compared for the different system settings. Three different UCAs were used (SonoVue(TM), BY963 and Levovist(TM)).

RESULTS

The Doppler time intensity curves showed a typical two phase decrease with a distribution phase alpha and an elimination phase beta with all three UCAs. Altering the system settings had a significant effect on the mean peak Doppler intensity for SonoVue(TM) (P=0.02) but not for BY963 or Levovist(TM) (P=0.07 and P=0.39, respectively), due to high variation of the Levovist(TM) and BY963 intensity values. There were no significant differences between the alpha slopes of BY963 and Levovist(TM) (P=0.96), or the beta slope of Levovist(TM) and SonoVue(TM) (P=0.62), when the results of all system settings were combined.

CONCLUSION

Different Doppler system settings show no significant influence on the decrease of mean Doppler intensity, but have a significant effect on peak intensity.

Myocardial Perfusion Abnormalities by Intravenous Administration of the Contrast Agent NC100100 in an Experimental Model of Coronary Artery Thrombosis and Reperfusion

The aim of this study was to evaluate a second-generation echo contrast agent (NC100100) for the study of myocardial perfusion. In eight anesthetized open-chest dogs, this agent was injected intravenously under baseline conditions, during acute coronary thrombosis, and after reperfusion, using both fundamental (FI) and harmonic (HI) imaging, both continuous and intermittent imaging, and both ultrasound (US) and integrated backscatter (IBS) imaging. Contrast injections did not modify the hemodynamic parameters. With all imaging modalities, myocardial contrast enhancement (MCE) was higher with intermittent than with continuous imaging (134 vs 82 gray level/pixel using FI, P = 0.02; 62 vs 32 acoustic units using US HI, P = 0.02; and 52 vs 12 dB using IBS, P = 0.05). MCE equally increased using either US or IBS imaging. The accuracy of MCE in detecting perfusion defects during coronary occlusion and myocardial reperfusion after thrombolysis was very good (sensitivity and specificity = 93% and 95% and 89% and 93%, respectively). The extent of myocardial perfusion defects by echo contrast showed a closer correlation with microspheres using HI (r = 0.82) than FI (r = 0.53). Thus, the intravenous administration of NC100100 during intermittent HI allows myocardial perfusion abnormalities to be accurately detected during acute myocardial infarction.

The influence of different gases on acoustic properties of a spherosome-based ultrasound contrast agent (BY963). A transcranial Dopplersonography study

Ultrasound contrast agents improve the signal-to-noise ratio of reflected ultrasound, enhancing the diagnostic value of transcranial Doppler (TCD). In dog studies, we investigated the time course of TCD signal amplitude after application of a phospholipid-containing ultrasound contrast agent (BY963) filled with different gases. The median time of Doppler amplitude enhancement exceeding 5 dB was determined using isoflurane-, isopentane-, trichlortrifluoroethane-, air-, argon-, and perfluoropentane-filled BY963 (69, 72, 75, 78, 88, and 245 seconds respectively). The decrease of time-intensity curve and the duration of signal enhancement showed significant differences comparing the different gases (p = 0.04 and 0.03, respectively). The time course of in vitro stability of BY963 agitated with the different gases measured by absorbance of light (500 nm) showed a retarded decay for perfluoropentane, a rapid decrease for air, isopentane, trichlortrifluoroethane, and argon, and a very rapid decrease using isoflurane. The time course of the different gases depended on the physiochemical properties (lipophilicity and the solubility in water) of the gas encoated in the phospholipid shell. Perfluoropentane-filled BY963 showed the highest in vitro stability and the longest duration of TCD enhancement compared with the other gases used.

Assessment of myocardial perfusion by intermittent harmonic power Doppler using SonoVue, a new ultrasound contrast agent

RATIONALE AND OBJECTIVES

The authors evaluated the potential of SonoVue, a new echo contrast agent, for the detection of myocardial perfusion abnormalities using intermittent harmonic power Doppler (IHPD) imaging and different pulse repetition frequencies (PRFs).

METHODS

Experiments were performed in vitro (in a tissue-mimicking phantom) and in vivo (in minipigs) in harmonic power Doppler using an ATL HDI 3000 with second harmonic software. SonoVue was injected intravenously in an auricular vein in bolus (dose range 0.01-0.05 mL/kg) in closed-chest animals or as an infusion (rate = 0.1 mL/kg/minute) in open-chest minipigs with reversible left anterior descending coronary artery (LAD) occlusion. The animals were imaged using IHPD gated on the electrocardiogram at end-systole (pulsing interval at each cardiac cycle). The efficacy of SonoVue was evaluated at six PRFs from 500 to 6000 Hz either qualitatively using a subjective scoring system or quantitatively using a digital image analyzer.

RESULTS

SonoVue at a dose of 0.01 mL/kg produced a strong and homogeneous myocardial opacification in IHPD. Higher doses prolonged the duration of the contrast effect. Varying the PRF allowed the discrimination of flow velocities in vitro and the detection of perfusion differences within the myocardium during transient LAD occlusion and during immediate reperfusion in vivo. Low PRFs were particularly useful to differentiate the ischemic bed from the healthy one during LAD occlusion. The high flows caused by coronary hyperemia during immediate reperfusion were detected clearly in the reperfused area at high PRFs.

CONCLUSIONS

SonoVue is a promising agent for myocardial opacification studies using IHPD. The latter imaging modality is particularly well suited for blood flow detection in tissues. Varying the PRF provides additional information on flow velocity and improves the detection of perfusion differences in the myocardium.

Detection of perfusion defects during coronary occlusion and myocardial reperfusion after thrombolysis by intravenous administration of the echo-enhancing agent BR1

The purpose of this study was to detect myocardial perfusion defects as a result of coronary occlusion and myocardial reperfusion after thrombolysis with intravenous (i.v.) administration of the echo contrast agent BR1 (Bracco Research, Switzerland), which consists of microbubbles (median diameter 2.5 microm) containing sulfur exafluoride in a phospholipidic shell. To generate a coronary thrombosis, a copper coil was advanced into the left circumflex coronary artery in eight anesthetized dogs with opened chest cavities. Coronary occlusion occurred 18 +/- 10 minutes after the insertion of the coil and was documented both by an electromagnetic flow meter (as zero blood flow) and by radiolabeled microspheres (as myocardial perfusion defect). After 2 hours of occlusion, streptokinase was infused i.v.; reperfusion was documented by both the flow-meter and microspheres. Left ventricular cavity enhancement was apparent after all contrast injections. Peak cavity intensity did not increase with dose and was not affected by signal processing (suggesting signal saturation), whereas the duration of contrast effect significantly increased with the dose (from 26 +/- 16 to 147 +/- 74 seconds). Myocardial contrast intensity also increased after contrast (from 15 +/- 12 to 21 +/- 18 gray level/pixel, p < 0.001). Contrast echo detected myocardial perfusion defects (corresponding to 17% +/- 11% of LV cross-sectional area) in all the injections performed during coronary occlusion and detected myocardial reperfusion with a sensitivity of 50% versus microspheres. The extent of perfusion defects by contrast echo showed a good correlation with microspheres (r = 0.73). Myocardial reperfusion was not detected by changes in heart rate, aortic pressure, pulmonary arterial pressure, cardiac output, left ventricular fractional area change, or wall-motion score index. Hemodynamic parameters were not affected by contrast injections. Thus, the i.v. administration of BR1 allows us to accurately detect myocardial perfusion defects during coronary occlusion and, to a lesser extent, myocardial reperfusion after thrombolysis.

Enhancement of ultrasonically-induced hemolysis by perfluorocarbon-based compared to air-based echo-contrast agents

Hemolysis induced by ultrasonic activation of various contrast-agent gas bodies was investigated. Canine whole blood, with high concentrations of the agents held in 1 mm thick chambers, was exposed in the nearfield of a 2.4-MHz ultrasound beam in a 37 degrees C water bath. Sterile phosphate buffered saline (PBS) served as a control agent without gas bodies. Albunex (Mallinckrodt Medical, St. Louis, MO) and Levovist (Schering AG, Berlin, Germany) represented the air-based contrast agents. The experimental agents FS069 (Optison, Molecular Biosystems Inc., San Diego, CA) and modified MRX-130 (ImaRx Pharmaceutical Corp., Tucson, AZ) represented perfluorocarbon-based contrast agents. No significant ultrasonically-induced hemolysis was detected for the PBS or Levovist suspensions. After 1 s continuous exposure, ultrasonically-induced hemolysis was significant for Albunex at 0.4 MPa or higher pressure amplitudes, for FS069 at 0.2 MPa and for modified MRX-130 at 0.4 MPa. Hemolysis found after pulsed exposure with 10 micros pulses and 1 ms pulse repetition period was significant for Albunex, FS069 and modified MRX-130 above thresholds of 1.1 MPa, 0.57 MPa and 1.6 MPa, respectively. FS069 led to more hemolysis after pulsed mode exposures of 1 s duration or longer than did Albunex. Reduced concentrations of gas bodies gave increased thresholds and reduced hemolysis. These results indicate that improvements in persistence of contrast agents, which increase their clinical utility, may also enhance the potential for cavitational bioeffects.

Echo enhancers and ultrasound imaging

The quality of diagnostic ultrasound images is sometimes limited by excessive acoustic attenuation within the organs and tissues. Ultrasound echo-enhancers help to overcome that limitation by increasing the intensity of the reflected signal. Acoustic principles dictate that the most effective enhancers are gas-filled microbubbles. The problem of producing a microbubble suspension stable enough for routine clinical use has been overcome in several ways. Newer developments are leading to enhancers with an active acoustic response and that have affinities for specific organs and tissues.

History of echocardiographic contrast agents

Since its experimental introduction over 30 years ago, the use of cardiac ultrasound has expanded expeditiously, particularly in the last decade. The inception of managed care has fueled this expansion because ultrasound technology has the potential to enhance cost-effective diagnosis and medical care. Another important factor driving the growth of cardiac ultrasound has been the recent and rapid development of contrast echocardiography (CE). This diagnostic technique, involving the injection of a contrast agent to enhance ultrasound imaging, provides a safe, noninvasive means of directly assessing myocardial perfusion and a host of other aspects of cardiovascular health and integrity.

Effect of microsphere size distribution on the ultrasonographic contrast efficacy of air-filled albumin microspheres in the left ventricle of dog hearts

RATIONALE AND OBJECTIVES

The in vitro ultrasonographic contrast efficacy of air-filled albumin microspheres has been found to depend on the size distribution of microspheres. The objective of the current study was to empirically describe the relationship between the size distribution of injected air-filled albumin microspheres and the in vivo contrast efficacy after lung capillary filtration in a dog model.

METHODS

Twenty different air-filled microspheres with large and well-defined differences in size distribution were prepared from nine different batches of Albunex (Molecular Biosystems Inc.) and subsequently characterized by Coulter counting. The in vivo ultrasonographic contrast enhancement of these preparations was investigated with a VingMed CFM750 in closed chest model in six mongrel dogs. The observed contrast efficacy, measured as gray-level enhancement in the left ventricle (LV), was correlated to the microsphere size distribution, using both univariate and multivariate approaches.

RESULTS

The results demonstrated a significant contribution to LV contrast efficacy from microspheres larger than approximately 7 microm, and a lack of contribution from microspheres smaller than approximately 7 microm. Linear relationships were found between LV contrast efficacy, and both the number concentration of microspheres between 8 to 12 microm and the total microsphere volume concentration. No significant covariance between in vivo contrast efficacy and the number concentration between 1 to 38 microm or 4 to 10 microm was observed. The multivariate model showed a significant contribution to the in vivo gray-level enhancement from microspheres in the size range 7 to 15 microm, with optimal efficacy per microsphere at approximately 13 microm.

CONCLUSIONS

Large microspheres (> 7 microm), which had been expected to be trapped in the lung capillary bed, contribute most of the observed ultrasound contrast in the LV of the heart.

Ultrasound Contrast Agents

The introduction of ultrasound contrast agents will bring new applications of this diagnostic imaging technology into clinical practice. Vascular, organ-specific, and oral agents are now in clinical trials and will soon be available. The development and properties of ultrasound contrast agents, most of which are based on gas-filled microbubbles, are reviewed. The first group of agents designed to overcome the limitations of free gas bubbles were of more uniform size but were either too large to cross the pulmonary capillary bed or lasted for only a short time in the circulation. The next group was able to produce enhancement over a period of minutes, but did not enhance the parenchyma of organs. The most recently developed intravenous agents exhibit parenchymal enhancement or are tissue-specific during B-mode imaging. Oral contrast agents may be used to reduce the artifacts created by gas in the gastrointestinal tract and to more clearly image the upper abdomen. Specific agents within each of the groups are described. The use of harmonic imaging is reviewed.

New contrast agents and technologies for myocardial contrast echocardiography

Images

Coulter counting and light diffraction analysis applied to characterisation of oil-water emulsions

Coulter counting and light diffraction techniques were successfully applied to the characterisation of the droplet concentration and size distribution in camphene-water and cyclohexane-water emulsions. Both of these techniques required a dilution of the emulsion prior to analysis, and it was found that the destabilizing effect on the droplets of such dilution could be overcome by performing the analyses at temperatures below the melting point of the oil phase. The storage stability of the camphene-water samples at 60 degrees C was reasonably good with a 5-20% change in the investigated parameters over a 24 h period. At room temperature camphene-water samples left to stand undisturbed were unaffected after 24 h, while continuous mixing of the emulsion on a roller board brought about a rapid amalgamation of the particles into larger aggregates. This fusion process was fully described only with the light diffraction analysis due to the broader measuring range of this technique. However, analysing emulsions with a droplet size range covered by both techniques gave identical results.

Gray-scale liver enhancement in VX2 tumor-bearing rabbits using BR14, a new ultrasonographic contrast agent

RATIONALE AND OBJECTIVES

We evaluated the potential of BR14, a novel gas-based echo contrast agent, for gray-scale liver imaging and VX2 tumor detection/delineation in the conventional and harmonic imaging modes.

METHODS

A single dose (0.2 mL/kg) of BR14 was administered to eight VX2 tumor-bearing rabbits. Imaging was performed with an ATL-HDI 3000. The B-mode gray levels were analyzed by videodensitometry in areas selected in the liver tissue, tumors, aorta, and the portal vein from frames recorded up to 1 hour after injection. The tumors were further assessed using subjective scores just before and after contrast injection, as well as 15 minutes later in both conventional gray-scale and harmonic imaging modes.

RESULTS

Gray-scale enhancement of the liver tissue was detectable soon after BR14 injection and remained at a high level even after clearance of the agent from the blood stream. On precontrast, of 42 observed tumors, 4 were perfectly detected (4/42). After injection of BR14, the number rose to 10/20 in the vascular phase and 12/20 in the delayed phase. In harmonic imaging, the corresponding numbers were even higher, 17/22 in the vascular phase and 18/22 in the delayed phase. The number of tumors perfectly delineated increased after BR14 from 1/42 to 3/20 in the vascular phase and 5/20 in the delayed phase. In the harmonic mode, 9 of 22 tumors were perfectly delineated in the vascular phase and 10 of 22 in the delayed phase.

CONCLUSIONS

BR14 is a promising new agent for the study of tissue perfusion and in particular for liver imaging. It shows not only strong, but also persistent gray scale enhancement of the parenchyma but not of the tumors. The increased conspicuousness allows considerable improvements in tumor detection and tumor delineation in conventional imaging and even more so in harmonic imaging.

Characteristics of transcranial Doppler signal enhancement using a phospholipid-containing echocontrast agent

BACKGROUND AND PURPOSE

Ultrasound attenuation caused by the skull is a major limitation of transcranial Doppler. Echocontrast agents (EAs) may solve this problem. The aim of the present study was to investigate the characteristics of a new echocontrast agent (BY963) containing air bubbles stabilized by phospholipids.

METHODS

Nine healthy volunteers received three different doses (2.5, 5.0, and 10 mL) of BY963 at an injection rate of 0.25 mL/s. The Doppler signal amplitude obtained from the middle cerebral artery was recorded with a 2-MHz pulsed-wave Doppler system. After complete decay of the signal enhancement, upward stroking of the veins of the upper arm was performed to evaluate the stability of the EA in the venous system.

RESULTS

A dose-dependent increase of at least 30 dB in the Doppler signal amplitude lasted 19 to 47, 35 to 64, and 48 to 126 heart cycles (68% range) after 2.5, 5.0, and 10 mL EA, respectively. In 6 cases, there was a biphasic increase in EA enhancement. Upward stroking of the forearm, in general 12 to 18 minutes after administration, caused a Doppler signal enhancement of at least 30 dB in 6 cases.

CONCLUSIONS

Each injection of BY963 caused a diagnostically relevant Doppler signal enhancement. A considerable amount of EA remained stable in the venous system for at least 12 minutes. The biphasic dose-response fits to models of dilution-indicator theory and indicates free recirculation, as well as a nonlinear washout curve.

Interactions between microbubbles and ultrasound: in vitro and in vivo observations

OBJECTIVES

We attempted to examine the interactions between ultrasound and microbubbles.

BACKGROUND

The interactions between microbubbles and ultrasound are poorly understood. We hypothesized that 1) ultrasound destroys microbubbles, and 2) this destruction can be minimized by limiting the exposure of microbubbles to ultrasound.

METHODS

We performed in vitro and in vivo experiments in which microbubbles were insonated at different frequencies, transmission powers and pulsing intervals. Video intensity decay was measured in vitro and confirmed by measurements of microbubble size and concentrations. Peak video intensity and mean microbubble myocardial transit rates were measured in vivo.

RESULTS

Imaging at lower frequencies and higher transmission powers resulted in more rapid video intensity decay (p = 0.01), and decreasing exposure of microbubbles to ultrasound minimized their destruction in vitro. Although these effects were also noted in vivo with venous injections of microbubbles, they were not seen with aortic root or direct coronary artery injections.

CONCLUSIONS

Ultrasound results in microbubble destruction that is more evident at lower frequencies and higher acoustic powers. Reducing the exposure of microbubbles to ultrasound minimizes their destruction. This effect is most marked in vivo with venous rather than aortic or direct coronary injections of microbubbles. These findings could lead to effective strategies for myocardial perfusion imaging with venous injections of microbubbles.

Preliminary study in differential contrast echography

Microbubble-based contrast agents have backscattering properties that differ greatly from those of soft tissues. These agents exhibit nonlinear scattering properties in response to incident acoustic energy, causing harmonic components in reflected energy. Even in linear scattering conditions, an important difference is observed in the frequency dependence of their backscatter coefficient, when compared to that of tissues. In this situation, any such differential behaviour can be exploited by imaging instrumentation to enhance the detection of agent-containing vessels against background tissue. The resulting B-mode image brightness (or pixel level) can thus be the representation of a local parameter computed from radio frequency (rf) signal processing of the raw echoes. The object of this article is to report on parametric imaging studies performed with Sonovue (formerly code named BR1, Bracco Research SA), aimed at assessing the contrast-enhancing potential of spectral rf signal processing. The technique used, termed here "differential contrast echography" (DCE), is applicable in real-time B-mode imaging. It is based on an on-line subtractive approach, using dual-channel signal processing to implement differential filtering and demodulation. In this preliminary work, DCE was implemented off-line, on rf echo signals digitised from commercial B-mode scanners. Data acquisition, DCE processing and complete B-mode image reconstruction were programmed on a personal computer. The images presented were produced from test phantoms as well as animal phased array scanning. The phantom included a flow channel, background scattering material, fixed echogenic targets and echo-free regions. Animal scanning was performed on rabbit liver. The results obtained from DCE show promising contrast-enhancing properties. The regions containing no contrast agent are significantly suppressed from the image, preferentially leaving the regions perfused by the contrast agent. This property was favourable to experimenting with image-overlay presentations, superimposing colour-coded DCE imaging with standard log-compressed grey-scale B-mode, in a way analogous to duplex imaging combining colour Doppler and B-mode.