An investigation of the relationship between ultrasound echo enhancement and Doppler frequency shift using a pulsatile arterial flow phantom.

RATIONALE AND OBJECTIVES: Based on the echo-enhancing effect of microbubbles, various agents have been developed to improve the diagnostic confidence in patients with inadequate Doppler signals. In the clinical trials of the echo enhancer Levovist, there were a few isolated cases in which the maximum flow velocities of the enhanced Doppler spectra appeared to higher than the velocities in the nonenhanced baseline spectra. This raised the concern that echo enhancement could give a false indication of maximum flow velocity. This study investigated whether a systematic association between echo enhancement and velocity shift exists. METHODS: A pulsatile flow phantom that simulated the elasticity of blood vessels and the acoustic attenuation of extravascular tissue was used to compare enhanced with unenhanced Doppler spectra under accurately reproducible flow conditions. The experiments were carried out with varied sound attenuation and evaluated with dedicated spectral analysis software that included a special averaging tool. RESULTS: Levovist enhanced the Doppler signal by 16 to 31 dB, and the enhanced and unenhanced power spectra presented identical distribution of spectral power density under all flow conditions. CONCLUSIONS: The measurements gave no evidence that echo enhancement with Levovist falsifies the Doppler measurement of flow velocity.

Sound scattering and localized heat deposition of pulse-driven microbubbles

The sound scattering of free microbubbles released from strongly driven ultrasound contrast agents with brittle shell (e.g., Sonovist) is studied numerically. At high peak pressure of the driving pulses, the bubbles respond nonlinearly with cross sections pronouncedly larger than in the linear case; a large portion of the energy is radiated into high frequency ultrasound. Subsequent absorption of these high frequencies in the surrounding liquid (blood) diminishes the effective scattering cross section drastically. The absorption results in highly localized heating, with a substantial temperature rise within the first few microm from the bubble surface. The maximum heating in 1 microm distance is strongly dependent on driving pressure. Temperature elevations of more than 100 K can be achieved for amplitudes of Pa approximately 30 atm, which coincides with the highest pressures used in ultrasound diagnostics. The perfectly spherical collapses assumed here occur rarely, and the heating is highly localized and transient (approximately 10 micros). Therefore, a thermal hazard would only be expected at driving pressures beyond the diagnostic range.

[Pulsatile flow model with elastic blood vessels for duplex ultrasound studies]. / Pulsatiles Strömungsmodell mit elastischen Gefässen für duplexsonographische Untersuchungen.

Using ultrasound duplex technique flow phenomena in patients' circulation can be examined. For the interpretation of these examinations it is necessary to have extensive knowledge on flow influencing parameters. This can be easily obtained from simplified flow models. This article describes the components of a flow model that allows examination of ultrasonic contrast media flowing through an artificial heart and vessel mimicking tubes. The artificial heart is the drive which pumps a water glycerol cellulose mixture through the circulation in a pulsatile manner. The shape of the ventricle, the compliance of the aorta, the viscosity of the flow medium and the wall elasticity of the examination vessel were taken into account. The attenuation caused by the surrounding tissue is simulated by a variable layer of castor oil. The flow model is suitable to produce flow profiles that are very similar to physiological profiles.

Wideband harmonic imaging: a novel contrast ultrasound imaging technique.

A novel ultrasonic imaging method, wideband harmonic imaging, for nonlinear imaging of microbubble contrast agents is evaluated. In wideband harmonic mode, two pulses of alternate phase are send out. The image is then processed from the sum of both pulses, resulting in an image of nonlinear scatterers such as microbubbles. A prototype ultrasound system, Siemens Elegra, was evaluated with in vitro investigations and animal trials, using conventional, harmonic and wideband harmonic settings with the galactose based ultrasound contrast agent Levovist. Wideband harmonic imaging offers superior sensitivity for ultrasound contrast agents compared to conventional imaging and harmonic imaging. At low transmit power settings (MI 0. 1-0.5) the nonlinear response is already sufficient to generate a image of the blood pool distribution of Levovist in the rabbit kidney including the microvasculature, with clear delineation of vessels and perfused parenchyma. At high transmit amplitudes, nonlinear tissue response reduced the apparent image contrast between contrast agent and tissue. The results suggest that wideband harmonic imaging is currently the most sensitive contrast imaging technique, maintaining highest spatial resolution. This may add to image quality and offer new clinical potential for the use of ultrasound contrast agents such as Levovist.