I. Imaging principles
Micro-bubbles
Interaction of micro-bubbles and ultrasound
Contrast specific imaging technology
High Power Techniques – Intermittent Imaging
Triggered harmonic imaging
Harmonic Power Doppler
Pulse Inversion Doppler
Ultraharmonic imaging
Low Power Techniques – Real Time Imaging
Power pulse inversion imaging
Power modulation imaging
Bubble administration
II. Left ventricular opacification
LV volume measurement
LVO and wall motion analysis
III. Myocardial contrast echocardiography
The ischaemic cascade
Coronary circulatory physiology
Myocardial blood volume
Normal physiology of perfusion
Qualitative assessment of myocardial contrast for diagnosis of CAD
Signal intensity
Perfusion distribution
Rate of filling
Validation of qualitative contrast echo for diagnosis of CAD
Author | CAD | No CAD | Sensitivity MCE | Specificity MCE | Frequency of angiography |
---|---|---|---|---|---|
Cwajg [42] | 32 | 13 | 87% | _ | All 45 |
Shimoni [41] | 28 | 16 | 75% | 100% | 44 (44%) of 101 |
Heinle [10] | 12 | 3 | 75% | 67% | 15 (12%) of 123 |
Wei [43] | 15 | - | 100% | - | 15 (28%) of 54 |
Rocchi [55] | 12 | - | 89% | - | 12 (48%) 25 |
Olszowska [56] | 44 | - | 97% | - | All 44 |
Moir [57] | 43 | 27 | 91% | 70% | 70 of 85 |
Quantitative myocardial contrast echo for diagnosis of CAD
Contrast Echo and myocardial viability in chronic CAD
Safety of contrast echocardiography
IV. Conclusion
High Power Intermittent Imaging
| Acquisition difficulty | Amount of contrast used | Amplitude of micro-bubble backscatter | Dynamic range | Greyscale or colour | Processed Backscatter | Myocardial perfusion | Wall motion | Artefacts |
---|---|---|---|---|---|---|---|---|---|
Tissue Harmonic Imaging | challenging | low | high | wide | grey | harmonic | yes | no | yes |
Ultraharmonic | challenging | low | high | wide | grey | harmonic | yes | no | yes |
Pulse inversion | challenging | low | high | wide | grey | harmonic | yes | no | yes++ |
Harmonic Power Doppler | challenging | low | high | wide | colour | harmonic | yes | no | yes |
Low Power Continuous Imaging
| |||||||||
Power Pulse inversion |
easy
|
high
|
low
|
narrow
|
colour
| harmonic |
yes
|
yes
|
yes
|
Power modulation |
easy
|
high
|
low
|
narrow
|
either
|
fundamental
|
yes
|
yes
|
yes
|
Distal coronary artery pressure | Arteriolar resistance | Pre-capillary pressure | Trans-capillary pressure | RBC velocity | MBV | |
---|---|---|---|---|---|---|
No stenosis REST | 90 mm Hg | Normal 45 mmHg | 45 mmHg | 30 mmHg | Normal | Normal |
No stenosis STRESS | 90 mm Hg | ↓ Maximal 25 mmHg | 65 mmHg | 30 mmHg | ↑ | ↑ |
Stenosis REST | 75 mm Hg | ↓ Sub-maximal 30 mmHg | 45 mmHg | 30 mmHg |
Normal
|
Normal
|
Stenosis STRESS | 60 mm Hg | ↓ Maximal 25 mmHg | 35 mmHg | 30 mmHg | ↓ | ↓ |