IntroductionThree major recent advances have significantly impacted the field of ultrasound contrast sonography. Microbubbles have become potent agents affecting tissue echogenicity with standard sonography at miniscule doses. Digital systems have increased imaging flexibility and improved both contrast and spatial resolution. Greater understanding of bubble interaction with sound has allowed for manipulation of the sound beam to promote image contrast by suppressing non-contrast-containing tissues. Advances in digital systems and transducers, and the characteristics of microbubbles that makes them so effective, are discussed elsewhere. This report discusses contrast-specific imaging that to date has relied on two specific characteristics unique to microbubbles: sensitivity to ultrasound pressure and nonlinear behavior when exposed to the compressive and rarefactive phases of the ultrasound wave. These microbubble characteristics and the emerging imaging techniques that utilize them to promote image contrast are highlighted and the impact of this technology on clinical applications is presented.
Bubble destructionMicrobubble systems are susceptible to ultrasound pressure [1]. As bubbles resonate under the compressive and expansive forces of the sound wave, their diameter decreases during compression but can increase by several multiples during expansion. It is hypothesized that the surface area of the emulsion layer that stretches with the square of the bubble radius exceeds its ability to cover the bubble surface and looses molecules that during the next compression wave leads to a smaller bubble. The smaller radius increases surface tension and promotes the loss of gas. Finally, when the bubble size approaches its critical radius, the partial pressure of the perfluorocarbon (PFC) exceeds its vapor pressure, the PFC converts to liquid loosing its reflectivity by ten orders of magnitude [2] and the air dissolves in plasma. In the case of less elastic shells, the shell fractures during expansion releasing the gas that subsequently disappears within several hundred milliseconds. The freed PFC is either phagocytosed, dissolved in lipids, evaporated through the lungs, and/or added to other PFC vapor containing microbubbles that are at a lower vapor pressure. Bubble destruction is dependent on the characteristics of the agent, exposure time, and beam intensity. Tissue enhancement decreases more rapidly as the sensitivity of the agent to ultrasound increases, as transmit power or power deposition increases, as transit time through the exposed field increases, and as the influx of new unexposed bubbles into the field decreases [3]. The loss of microbbubles to ultrasound has both advantages and disadvantages.The major disadvantage is the shorter enhancement period. Should tissue enhancement be the goal, then imaging with low power settings and intermittent imaging at slow frame rates becomes important. We found that at 1 frame/s, there was optimal liver enhancement while allowing the sonographer the ability to maintain a...