Contrast echocardiography

Image enhancement by acoustic conditioning of ultrasound contrast agents

A novel contrast imaging technique has been developed for use with microbubble contrast agents. It employs two acoustic fields: there is an excitation field for conditioning microbubbles and an imaging field for detecting microbubbles. The maximum increases (due to microbubble conditioning) in scattered first and second harmonic signals were 14.5 and 16 dB, respectively. This technique is unique for effectively enhancing the blood-to-tissue image contrast.

Automated quantitative analysis of the shift of frequency spectra generated by attenuated signals from contrast microbubbles

The ultrasound-induced harmonic microbubble response spectrum is known to shift to lower frequencies with increasing tissue attenuation. We hypothesized that this shift could be reproducibly detected in received broadband radiofrequency spectra. We used an automatic Gaussian curve-fitting technique to measure the mean harmonic response generated by three different contrast agents at six incremental levels of attenuation. Analytical curve fitting identified a consistent, reproducible, and statistically significant shift in mean harmonic frequency with increasing attenuation. The presented method could be a step toward attenuation estimation by contrast harmonic imaging; optimization of harmonic signal reception by ultrasound systems; and, ultimately, automatic detection of contrast agents in tissue.

Feasibility of Performing Real-Time Myocardial Contrast Echocardiography During Clinical Dobutamine Stress Echocardiography in Technically Difficult Patients

Myocardial contrast echocardiography (MCE) has emerged as an alternative to nuclear medicine perfusion imaging. The aim of this study was to evaluate the feasibility of performing and the interpretation of MCE for perfusion imaging in a clinical laboratory. The study population consisted of 150 consecutive patients referred for dobutamine stress echocardiography (DSE) to determine the presence of myocardial ischemia. Echocardiographic perfusion images were digitized at rest and at peak dobutamine infusion for later review. A total of 12 myocardial segments in the apical four and two chamber views were graded as no perfusion, minimal perfusion, definite perfusion, or not able to evaluate. Of 3600 possible segments, a total of 2926 (81%) were able to be graded at either rest or peak dobutamine. At rest, 79% of segments were graded for perfusion (1419 of 1800 segments). At peak dobutamine infusion, 84% of segments were graded for perfusion (1507 of 1800 segments). The results demonstrate that MCE is clinically feasible to perform and interpret during DSE on a routine daily basis.

High-resolution functional imaging with ultrasound contrast agents based on RF processing in an in vivo kidney experiment

Knowledge of the relative tissue perfusion distribution is valuable in the diagnosis of numerous diseases. Techniques for the assessment of the relative perfusion distribution, based on ultrasound (US) contrast agents, have several advantages compared to established nuclear techniques. These are, among others, a better spatial and temporal resolution, the lack of exposure of the patient to ionizing radiation and the relatively low cost. In the present study, US radiofrequency (RF) image sequences are acquired, containing the signal intensity changes associated with the transit of a bolus contrast agent through the microvasculature of a dog kidney. The primary objective is to explore the feasibility of calculating functional images with high spatial resolution. The functional images characterize the transit of the contrast agent bolus and represent distributions of peak time, peak value, transit time, peak area, wash-in rate and wash-out decay constant. For the evaluation of the method, dog experiments were performed under optimized conditions where motion artefacts were minimized and an IA injection of the contrast agent Levovist was employed. It was demonstrated that processing of RF signals obtained with a 3.5-MHz echo system can provide functional images with a high spatial resolution of 2 mm in axial resolution, 2 to 5 mm in lateral resolution and a slice thickness of 2 mm. The functional images expose several known aspects of kidney perfusion, like perfusion heterogeneity of the kidney cortex and a different peripheral cortical perfusion compared to the inner cortex. Based on the findings of the present study, and given the results of complimentary studies, it is likely that the functional images reflect the relative perfusion distribution of the kidney.

In vivo magnetic resonance vascular imaging using laser-polarized 3He microbubbles

Laser-polarized gases (3He and 129Xe) are currently being used in magnetic resonance imaging as strong signal sources that can be safely introduced into the lung. Recently, researchers have been investigating other tissues using 129Xe. These studies use xenon dissolved in a carrier such as lipid vesicles or blood. Since helium is much less soluble than xenon in these materials, 3He has been used exclusively for imaging air spaces. However, considering that the signal of 3He is more than 10 times greater than that of 129Xe for presently attainable polarization levels, this work has focused on generating a method to introduce 3He into the vascular system. We addressed the low solubility issue by producing suspensions of 3He microbubbles. Here, we provide the first vascular images obtained with laser-polarized 3He. The potential increase in signal and absence of background should allow this technique to produce high-resolution angiographic images. In addition, quantitative measurements of blood flow velocity and tissue perfusion will be feasible.

Contrast echocardiography: review and future directions

Recent developments and advances in contrast echocardiography have been made to improve the diagnosis and evaluation of cardiac structures and function. By coupling new developments in acoustic instrumentation with new contrast agents, information that was previously difficult or impossible to gather by standard 2-dimensional echocardiography can now be obtained. Numerous studies have been published confirming the advantages of using contrast during echocardiographic studies, particularly with stress testing and myocardial perfusion. This review aims to summarize (1) the various contrast agents that are available or being developed; (2) factors that have been found to affect the strength of enhanced signals; (3) the new developments in instrumentation that improve the ability of scanners to differentiate echo contrast from cardiac tissue; and (4) the documented and possible future uses of contrast echocardiography.

Placenta accreta: imaging by gray-scale and contrast-enhanced color Doppler sonography and magnetic resonance imaging

Antepartum diagnosis of placenta accreta on the scarred myometrium of the isthmus uteri after previous cesarean section was made in 2 pregnancies. Antepartum sonographic examination revealed abnormal bulging of placental tissue toward the bladder cavity and arcuate arteries within the bladder wall. Magnetic resonance imaging revealed the depth and extent of placental invasion into the myometrium of the isthmus and the bladder muscular layer. Low-resistance pulsatile intervillous flow was recorded within the placenta in 1 case. Both magnetic resonance imaging and contrast-enhanced color Doppler sonography were informative in the other of these cases, in which the patient was conservatively managed during pregnancy and after delivery.

Clinical applications of ultrasound contrast agents

Within the last decade safe and practical ultrasound contrast agents have been introduced. Most of these are based on gas-filled microbubbles, which markedly enhance Doppler signals and, in some cases, also gray-scale images. The clinical improvements expected from ultrasound contrast is reviewed. Tissue-specific contrast agents constitute another area of potential clinical significance. One particular agent is taken up by the reticulo-endothelial system and produces so-called acoustic emission signals when imaged. An introduction to the unique clinical applications of acoustic emission is given. Harmonic imaging is a new contrast-specific imaging modality, which utilizes the nonlinear properties of some agents in an attempt to alleviate current limitations of ultrasound contrast studies. Examples of harmonic images are presented.

Reduced forward output states affect the left ventricular opacification of intravenously administered Albunex

Albunex is an Food and Drug Administration-approved ultrasound contrast agent used for the enhancement of left ventricular endocardial borders. To determine the efficacy of intravenously administered Albunex with regard to left ventricular opacification (LVO), a retrospective analysis of 117 patients who received 202 injections of Albunex for enhancement of endocardial borders was done (dose 0.08 to 0.22 ml /kg). Patients were routinely referred to our echocardiography laboratory for stress echocardiography for standard indications. Optimized settings for contrast enhancement (3.5 MHz transducer frequency and maximum dynamic range) were used. Four observers graded LVO on a scale from 0 to 3 (0 = no Albunex seen in the ventricular cavity; 3 = Albunex densely seen in the ventricular cavity). Overall, LVO was reported in 166 (82%) of 202 injections or in 91 (78%) of 117 patients. A significant reduction in LVO was noted in patients with mitral regurgitation, tricuspid regurgitation, atrial fibrillation, systolic dysfunction, or pulmonary hypertension (increased pulmonary artery systemic pressure). LVO was seen in 88% of the patients without these conditions. However, only 12 (44%) of 27 patients with one or more of the above conditions had LVO (p < 0.05). LVO can be achieved in the majority of patients after intravenously administered Albunex when imaged with optimal transducer settings. A subset of patients with systolic dysfunction, mitral regurgitation, tricuspid regurgitation, atrial fibrillation, or increased pulmonary artery systemic pressure has less effective LVO with Albunex. Heart disease associated with decreased forward flow appears to be associated with diminished LVO.

Ultrasound contrast media and their use in obstetrics and gynecology

Contrast media have gained acceptance to enhance ultrasonography in many fields of medicine; in particular, cardiology. Several agents have been described and many more are being manufactured and tested. By increasing the number of strong sound scatterers, these agents improve images by increasing the amount of echoes. This is true both for grey-scale and color or Doppler imaging. Their use in obstetrics is very limited at the moment because of safety issues. In a laboratory setup, they have been shown to markedly enhance placental imaging. In gynecology, imaging of the uterine cavity and Fallopian tubes is greatly improved. A potential area where ultrasound contrast may find a role is gynecological oncology. Vascularity is increased in many tumors, but usually vessel diameter is small and velocity low. One can therefore expect future use of the ultrasound contrast agents in ovarian or other gynecological neoplasms.

Optimizing albunex in the left ventricle: an analysis of the technical parameters of four ultrasound systems in canines and humans

Albunex, an intravascular ultrasound contrast agent, has been used clinically to enhance echocardiographic images. The purpose of this study if (1) to determine whether varying the settings on commercially available ultrasound machines has an effect on left ventricular opacification after intravenously administered Albunex and if there is an effect on left ventricular opacification and (2) to determine the ideal settings for each ultrasound scanner. Six canine hearts were imaged with 1 ml injections of intravenously administered Albunex while varying the transducer frequency, preprocessing curves, postprocessing curves, and dynamic range on a variety of ultrasound units. Subsequently 50 human subjects underwent imaging with the various machines while the dynamic range and transducer frequencies were altered. All subjects received two or three intravenous injections of 10 ml Albunex. The opacification of the left ventricular cavitary images in both parts of the study were interpreted visually on a scale of 0 to 4 (0 = none, 1 = trace, 2 = moderate, 3 = dense, and 4 = ideal) by four observers. The maximum compression and transducer frequency of 3.5 MHz showed significant improvement of left ventricular opacification in both canines and humans. These studies have shown that (1) varying the ultrasound unit's parameters affects the quality of left ventricular imaging when Albunex is used to enhance the image, and (2) higher compression and a transducer frequency of 3.5 MHz tend to enhance Albunex images of canine and human hearts.

Development of inherently echogenic liposomes as an ultrasonic contrast agent

Ultrasonic contrast agents have been developed for improved assessment of blood flow and tissue perfusion. Many of these agents are not inherently acoustically reflective (echogenic), and nearly all are not suitable for tissue specific targeting. The purpose of this study was to develop acoustically reflective liposomes, which are suitable for antibody conjugation, without using gas or any other agent entrapment. Echogenic liposomes were prepared from phosphatidylcholine (PC), phophatidylethanolamine (PE), phosphatidylglycerol (PG), and cholesterol (CH), using a dehydration/rehydration method. The formulation was optimized for higher acoustic reflectivity by varying the lipid composition. Liposomes were imaged with a 20 MHz intravascular ultrasonic imaging catheter. Echogenicity levels were expressed using pixel gray scale. The presence of PE and PG at specific concentrations improved echogenicity due to their effects on liposomal morphology as confirmed by freeze-etch electron microscopy. The acoustic reflectivity of liposomes was retained when liposomes were treated with blood at room temperature and 37 degrees C under in vitro conditions. It was demonstrated that the liposomes were also acoustically reflective in vivo after they were injected into a miniswine model. We have developed echogenic liposomes that are stable and suitable for tissue specific targeting as a novel contrast agent. This new contrast agent can be used for ultrasonic image enhancement and/or treatment of targeted pathologic sites.

Ultrasound contrast agents nucleate inertial cavitation in vitro

Some ultrasound contrast agents contain stable bodies of gas, and this study was undertaken to determine if these agents could provide nuclei for inertial cavitation. Inertial cavitation was detected and assessed by the measurement of the sonochemical hydrogen peroxide after exposure to 2.17-, 2.95- or 3.8-MHz ultrasound. A noncavitating system was obtained by removing cavitation nuclei from the rotating tube exposure chambers by vacuum degassing, and from the phosphate-buffered saline medium by filtering. Albunex added at 10-2, 10-3 or 10-4 dilutions, or Levovist added at 2 mg mL-1, 0.2 mg mL-1 or 0.02 mg mL-1 all initiated significant H2O2 production for 2.17-MHz ultrasound at 0.41 MPa or higher spatial peak pressure amplitude for 5 min exposure gated at 0.25 s on and off with 60-rpm rotation. Not rotating the tube virtually eliminated H2O2 production. For 2.5-min continuous exposure, both agents initiated significant H2O2 production for 2.95-MHz exposure at 0.58 MPa or higher, but not for 3.8-MHz exposure up to 1.16 MPa. Bubble-based ultrasound contrast agents therefore appear to be able to provide nuclei for inertial cavitation in the rotating tube exposure system.