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

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.

Perioperative Takotsubo Cardiomyopathy: A Systematic Review of Published Cases

“…We included cases where coronary angiography was not done as long as an alternative imaging technique, for example, computed tomography angiography, 7 myocardial contrast echocardiography, 8 cardiac magnetic resonance, 9 or radionuclide scan, 10 was used to rule out obstructive CAD and to aid in diagnosis of TCM. Any inclusion or exclusion discrepancy was resolved by consensus during round-table meetings with the third, independent reviewer (M.C.).…”

Contrast echocardiography in daily clinical practice

“…Coronary blood flow is equally distributed between the arteries and arterioles, capillary network, and venules. Myocardial blood volume represents a third of total coronary flow, of which more than 90% resides in the capillary network [ 22 ]. MCE relies on the intensity of the backscattered ultrasound from the filled capillaries with UCA and suppression of those reflected from the myocardial tissue.…”

Bedside myocardial perfusion assessment with contrast echocardiography

“…The first generation contrast agents, developed at the end of the 20 th century, have a lipid shell with an air core, are soluble and are able to pass through the pulmonary circulation but lose their echogenicity and dissolve rapidly. The second generation contrast agents were then developed and have high‐molecular weight gaseous cores, are less soluble than air, with stabilizing lipid or biopolymer shells and remain more stable under the ultrasound field and, therefore, have an increased lifespan in the circulation [ 9 ]. These preparations include the standard contrast agents used today: Definity, Optison (GE healthcare, Chalfont St Giles, UK) and Sonovue (Bracca, Milan, Italy).…”

“…These symptoms are usually relieved on cessation of contrast agent administration. There is a 1:10,000 chance of an anaphylaxis type reaction (considered secondary to the microbubble shell and possibly non‐IgE related) [ 9 ]. Contraindications include previous hypersensitivity to contrast agents or to blood products (e.g., albumin), severe pulmonary hypertension and cardiac right‐to‐left or bidirectional shunts.…”