Handbook of Contrast Echocardiography

by Becher, Harald; Burns, Peter N.; Kaul, Sanjiv, M.D.

• ISBN13: 9783540670834
• ISBN10: 3540670831
• Format: Hardcover
• Copyright: 2000-04-01
• Publisher: Springer Nature

Summary

Ultrasound contrast is rapidly becoming an integral part of echocardiography, the most widely used technique to image the heart. Its demonstrated ability to provide the first images of perfusion in the myocardium have elicited widespread interest in the cardiology community. This has been accompanied by rapid development of the agents and specialised imaging methods for their detection. This book is the result of the authors' combined experience in both research into the agents and their associated imaging techniques, and of clinical application of contrast echocardiography over a period of ten years. Its aim is to provide for the clinical echocardiographer a complete guide and reference for performing and interpreting a contrast echo study. The copious illustrations accompanying the text are supplemented by the generous contributions of more than a twenty worldwide authorities who have provided cases which demonstrate convincingly this new technology.

Table of Contents

Foreword	v
Preface	vii
Table of Contents	vii
Acknowledgements	xiv
Contrast agents for echocardiography: Principles and Instrumentation
The need for contrast agents in echocardiography	2	(1)
B-mode imaging	2	(1)
Doppler	3	(1)
Doppler examination of small vessels	4	(1)
Contrast agents for ultrasound	5	(11)
Contrast agent types	5	(3)
Blood pool agents
Selective uptake agents
Using a contrast agent	8	(4)
Preparation
Preparing for injection
Administration methods	12	(4)
Bolus
Infusion
Mode of action	16	(24)
Bubble behaviour and incident pressure	17	(1)
Linear Backscatter: Doppler enhancement	18	(2)
Nonlinear backscatter: harmonic imaging	20	(16)
The need for bubble-specific imaging
Harmonic imaging
The impact of harmonic imaging
Tissue harmonic imaging
Pulse inversion imaging
Power pulse inversion imaging
III - Transient disruption: intermittent imaging	36	(3)
Triggered imaging
Intermittent harmonic power Doppler
Summary	39	(1)
Safety considerations	40	(1)
New developments in contrast imaging	41	(1)
Tissue specific bubbles	41	(1)
Bubbles for therapy	41	(1)
Summary	42	(1)
References	42	(6)
Assessment of Left Ventricular Function by Contrast Echo
Physiology and pathophysiology of LV function	48	(1)
Available methods - The role of contrast	49	(2)
Systolic function: the need for endocardial border definition	49	(1)
Diastolic function: the need for pulmonary vanous flow recordings	50	(1)
Indications and selection of methods	51	(5)
Indications for contrast echo	51	(2)
LV border delineation
Detection, determination of size and shape of LV thrombi
Pulmonary venous How
Selection of patients	53	(1)
Selection of imaging methods	54	(2)
How to perform an LV contrast study	56	(21)
Fundamental B-mode	56	(3)
Contrast agent dose
Image acquisition and interpretation
Pitfalls and troubleshooting
Fundamental pulsed wave (PW) Doppler	59	(4)
Contrast agent dose
Image acquisition and interpretation
Pitfalls and troubleshooting
Harmonic B-mode	63	(4)
Contrast agent dose
Image acquisition and interpretation
Pitfalls and troubleshooting
Harmonic imaging of LV thrombi	67	(1)
Harmonic colour/power Doppler for LVO	68	(4)
Continuous imaging for evaluation of LV wall motion
Contrast agent dose
Image acquisition and interpretation
Pitfalls and troubleshooting
Triggered imaging for assessment of end-systolic and end-diastolic volumes and ejection fraction	72	(5)
Contrast agent dose
Image acquisition and interpretation
Pitfalls and troubleshooting
Summary	77	(1)
References	78	(4)
Assessment of Myocardial Perfusion by Contrast Echo
Physiology and pathophysiology of myocardial perfusion	82	(2)
Normal perfusion	82	(1)
Acute myocardial infarction	83	(1)
Chronic ischemic heart disease	83	(1)
Currently available methods for myocardial perfusion imaging	84	(2)
Stress ECG	84	(1)
Stress echo	84	(1)
Coronary How reserve (CFR)	85	(1)
Myocardial scintigraphy	85	(1)
Myocardial contrast echo	86	(1)
Indications and selection of methods	86	(6)
Indications	86	(2)
Selection of patients and contraindications	88	(1)
Selection of the imaging method	88	(4)
Harmonic power Doppler (HPD)
Harmonic B-Mode
Pulse inversion imaging
Power pulse inversion (PPI)
Special considerations for myocardial contrast	92	(5)
Impact of the scanplane	92	(2)
Triggered imaging	94	(3)
Incremental triggered imaging
Double or multiple trigger
Flash Echo
Power pulse inversion flash echo
Systolic versus diastolic trigger
Choice of agent and method of administration	97	(3)
Continuous infusion versus bolus injection	97	(2)
Preparation of contrast infusion	99	(1)
Adjustment of infusion rate	99	(1)
Instrument settings	100	(8)
Harmonic power Doppler	100	(3)
Harmonic B-mode	103	(5)
Pulse inversion imaging	108	(1)
Power pulse inversion	108	(1)
Image acquisition	108	(1)
Stress testing during myocardial contrast echo	109	(3)
Exercise and dobutamine stress	109	(1)
Vasodilator stress	109	(2)
Combined assessment of wall motion and myocardial perfusion	111	(1)
Reading myocardial contrast echocardiograms	112	(9)
Visual assessment of unprocessed recordings	112	(7)
Normal perfusion
Perfusion Defect
Visual assessment of post-processed recordings	119	(1)
Report of visual judgement	119	(2)
Clinical profiles/interpretation of myocardial contrast echo	121	(6)
Acute myocardial infarction	121	(2)
Scar or fibrosis versus viable myocardium	123	(1)
Coronary artery stenosis	124	(3)
Pitfalls and troubleshooting	127	(6)
Inadequate myocardial contrast	127	(2)
Contrast shadowing	129	(2)
Blooming	131	(1)
Wall motion artifacts	131	(2)
The bubble depletion artifact	133	(1)
Coronary flow reserve and myocardial contrast echo	133	(1)
What is coronary flow reserve?	134	(1)
Available methods - need for contrast enhancement	134	(1)
Coronary flow reserve: indications and selection of methods	135	(2)
Selection of patients	136	(1)
How to perform a CFR study	137	(5)
Intravenous lines	137	(1)
Contrast agent	137	(1)
Protocols to induce hyperemia	137	(2)
Image orientation for visualising blood flow in the LAD	139	(1)
Instrument settings	139	(2)
Combination with myocardial contrast echo (MCE)	141	(1)
Image acquisition and interpretation	142	(1)
Significance of an LAD stenosis	143	(1)
Follow-up of an LAD stenosis after PTCA	143	(1)
Pitfalls and troubleshooting	143	(4)
Angle of the vessel to the beam	143	(1)
Displacement of the sample volume	144	(1)
Flow in mammary artery	144	(1)
Bubble noise	145	(1)
Interpretation problems: impact of preload	146	(1)
Impact of blood pressure	146	(1)
Vasodilation during hyperemia	147	(1)
Summary	147	(1)
References	147	(7)
Methods for quantitative Analysis
Basic tools for image quantification	154	(5)
Single image quantification	155	(1)
Cineloop quantification	156	(3)
Reduction of data
Positioning Regions of Interest (ROI)
Automatic analysis
Advanced image processing: cases & examples	159	(11)
Single image quantification	159	(1)
Background subtraction	160	(4)
Analysing the time-course of enhancement	164	(6)
Intravenous bolus technique
Negative bolus technique
Real-time negative bolus technique
Summary	170	(1)
References	170	(2)
Glossary	172	(8)
Index	180