J Cardiovasc Ultrasound.  2014 Sep;22(3):101-110. 10.4250/jcu.2014.22.3.101.

A Primer on the Methods and Applications for Contrast Echocardiography in Clinical Imaging

• Seol SH
• Lindner JR

• KMID: 2045424
• DOI: http://doi.org/10.4250/jcu.2014.22.3.101

Abstract

Contrast echocardiography is broadly described as a variety of techniques whereby the blood pool on cardiac ultrasound is enhanced with encapsulated gas-filled microbubbles or other acoustically active nano- or microparticles. The development of this technology has occurred primarily in response to the need improve current diagnostic applications of echocardiography such as the need to better define left ventricular cavity volumes, regional wall motion, or the presence or absence of masses and thrombi. A secondary reason for the development of contrast echocardiography has been to expand the capabilities of echocardiography. These new applications include myocardial perfusion imaging for detection of ischemia and viability, perfusion imaging of masses/tumors, and molecular imaging. The ability to fill all of these current and future clinical roles has been predicated on the ability to produce robust contrast signal which, in turn, has relied on technical innovation with regards to the microbubble contrast agents and the ultrasound imaging paradigms. In this review, we will discuss the basics of contrast echocardiography including the composition of microbubble contrast agents, the unique imaging methods used to optimize contrast signal-to-noise ratio, and the clinical applications of contrast echocardiography that have made a clinical impact.

Keyword

Microbubbles; Left ventricular opacification; Myocardial contrast echocardiography

MeSH Terms

Contrast Media
Echocardiography*
Ischemia
Microbubbles
Molecular Imaging
Myocardial Perfusion Imaging
Perfusion Imaging
Signal-To-Noise Ratio
Ultrasonography
Contrast Media

Figure

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  Fig. 1 Apical four-chamber (A and C) and two-chamber views (B and D), end-diastolic frame, showing poor endocardial delineation at baseline (top), which improves after contrast injection (bottom). Reprinted with permission.1)

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  Fig. 2 Illustration of the coronary circulation showing the distribution in volume of blood in the different coronary vascular compartments.

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  Fig. 3 Kaplan-Meier curves of event free survival (death, myocardial infarction, heart failure) in patients presenting to the emergency department with chest pain and intermediate Thrombolysis In Myocardial Infarction risk score undergoing myocardial contrast echocardiography to evaluate RF and MP. Reproduced with permission.23) RF: regional function, MP: myocardial perfusion.

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  Fig. 4 Example of contrast-enhanced ultrasound perfusion imaging in PAD. The top images illustrate background-subtracted color-coded images and corresponding time-intensity data at rest and during plantar flexion exercise from the calf muscles of a normal control subject. The bottom images show similar data from a patient with PAD and moderate claudication. Flow reserve from time-intensity data are at the top of each graph. Reproduced with permission.38) PAD: peripheral artery disease, BG: background image obtained immediately after microbubble destruction, s: seconds.

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  Fig. 5 Volumetric oscillation of microbubbles in an acoustic field. The images at the bottom were obtained approximately 330 ns apart by high-speed transillumination microscopy and illustrate oscillation of a microbubble during ultrasound (Courtesy of Postema M, Bouakaz A, and de Jong N, Erasmus University). Bubble compression and expansion occur during different pressure phases of the acoustic wave, shown schematically by the location of frames a-e. Reproduced with permission.39)

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  Fig. 6 Images obtained by myocardial contrast echocardiography at rest (top, apical two-chamber view) and during vasodilator stress (bottom, apical 4-chamber view) from two separate patients without coronary artery disease. Images are shown immediately after a destructive pulse sequence and then on subsequent end-systolic frames (one to five).

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