Ultrasound Contrast Agents: Development of the Field and Current Status

Nanosized Contrast Agents in Ultrasound Molecular Imaging

Applying nanosized ultrasound contrast agents (nUCAs) in molecular imaging has received considerable attention. nUCAs have been instrumental in ultrasound molecular imaging to enhance sensitivity, identification, and quantification. nUCAs can achieve high performance in molecular imaging, which was influenced by synthetic formulations and size. This review presents an overview of nUCAs from different synthetic formulations with a discussion on imaging and detection technology. Then we also review the progress of nUCAs in preclinical application and highlight the recent challenges of nUCAs.

Molecular Imaging and Non-molecular Imaging of Atherosclerotic Plaque Thrombosis

Thrombosis in the context of atherosclerosis typically results in life-threatening consequences, including acute coronary events and ischemic stroke. As such, early detection and treatment of thrombosis in atherosclerosis patients is essential. Clinical diagnosis of thrombosis in these patients is typically based upon a combination of imaging approaches. However, conventional imaging modalities primarily focus on assessing the anatomical structure and physiological function, severely constraining their ability to detect early thrombus formation or the processes underlying such pathology. Recently, however, novel molecular and non-molecular imaging strategies have been developed to assess thrombus composition and activity at the molecular and cellular levels more accurately. These approaches have been successfully used to markedly reduce rates of atherothrombotic events in patients suffering from acute coronary syndrome (ACS) by facilitating simultaneous diagnosis and personalized treatment of thrombosis. Moreover, these modalities allow monitoring of plaque condition for preventing plaque rupture and associated adverse cardiovascular events in such patients. Sustained developments in molecular and non-molecular imaging technologies have enabled the increasingly specific and sensitive diagnosis of atherothrombosis in animal studies and clinical settings, making these technologies invaluable to patients' health in the future. In the present review, we discuss current progress regarding the non-molecular and molecular imaging of thrombosis in different animal studies and atherosclerotic patients.

Closed-loop feedback control of microbubble diameter from a flow-focusing microfluidic device

Real-time observation and control of particle size and production rate in microfluidic devices are important capabilities for a number of applications, including the production, sorting, and manipulation of microbubbles and droplets. The production of microbubbles from flow-focusing microfluidic devices had been investigated in multiple studies, but each lacked an approach for on-chip measurement and control of microbubble diameter in real time. In this work, we implement a closed-loop feedback control system in a flow-focusing microfluidic device with integrated on-chip electrodes. Using our system, we measure and count microbubbles between 13 and 28  μ m in diameter and control their diameter using a proportional-integral controller. We validate our measurements against an optical benchmark with R 2 = 0.98 and achieve a maximum production rate of 1.4 × 10 5 /s. Using the feedback control system, the device enabled control in microbubble diameter over the range of 14-24  μ m.

Ligand Distribution and Lipid Phase Behavior in Phospholipid-Coated Microbubbles and Monolayers

Phospholipid-coated targeted microbubbles are ultrasound contrast agents that can be used for molecular imaging and enhanced drug delivery. However, a better understanding is needed of their targeting capabilities and how they relate to microstructures in the microbubble coating. Here, we investigated the ligand distribution, lipid phase behavior, and their correlation in targeted microbubbles of clinically relevant sizes, coated with a ternary mixture of 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) or 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC), with PEG40-stearate and DSPE-PEG2000. To investigate the effect of lipid handling prior to microbubble production in DSPC-based microbubbles, the components were either dispersed in aqueous medium (direct method) or first dissolved and mixed in an organic solvent (indirect method). To determine the lipid-phase behavior of all components, experiments were conducted on monolayers at the air/water interface. In comparison to pure DSPC and DPPC, the ternary mixtures had an additional transition plateau around 10-12 mN/m. As confirmed by infrared reflection absorption spectroscopy (IRRAS), this plateau was due to a transition in the conformation of the PEGylated components (mushroom to brush). While the condensed phase domains had a different morphology in the ternary DPPC and DSPC monolayers on the Langmuir trough, the domain morphology was similar in the coating of both ternary DPPC and DSPC microbubbles (1.5-8 μm diameter). The ternary DPPC microbubbles had a homogenous ligand distribution and significantly less liquid condensed (LC) phase area in their coating than the DSPC-based microbubbles. For ternary DSPC microbubbles, the ligand distribution and LC phase area in the coating depended on the lipid handling. The direct method resulted in a heterogeneous ligand distribution, less LC phase area than the indirect method, and the ligand colocalizing with the liquid expanded (LE) phase area. The indirect method resulted in a homogenous ligand distribution with the largest LC phase area. In conclusion, lipid handling prior to microbubble production is of importance for a ternary mixture of DSPC, PEG40-stearate, and DSPE-PEG2000.

Theoretical and Experimental Gas Volume Quantification of Micro- and Nanobubble Ultrasound Contrast Agents

The amount of gas in ultrasound contrast agents is related to their acoustic activity. Because of this relationship, gas volume has been used as a key variable in normalizing the in vitro and in vivo acoustic behavior of lipid shell-stabilized bubbles with different sizes and shell components. Despite its importance, bubble gas volume has typically only been theoretically calculated based on bubble size and concentration that is typically measured using the Coulter counter for microbubbles and nanoparticle tracking analysis (NTA) for nanoscale bubbles. However, while these methods have been validated for the analysis of liquid or solid particles, their application in bubble analysis has not been rigorously studied. We have previously shown that resonant mass measurement (RMM) may be a better-suited technique for sub-micron bubble analysis, as it can measure both buoyant and non-buoyant particle size and concentration. Here, we provide validation of RMM bubble analysis by using headspace gas chromatography/mass spectrometry (GC/MS) to experimentally measure the gas volume of the bubble samples. This measurement was then used as ground truth to test the accuracy of theoretical gas volume predictions based on RMM, NTA (for nanobubbles), and Coulter counter (for microbubbles) measurements. The results show that the headspace GC/MS gas volume measurements agreed well with the theoretical predictions for the RMM of nanobubbles but not NTA. For nanobubbles, the theoretical gas volume using RMM was 10% lower than the experimental GC/MS measurements; meanwhile, using NTA resulted in an 82% lower predicted gas volume. For microbubbles, the experimental gas volume from the GC/MS measurements was 27% lower compared to RMM and 72% less compared to the Coulter counter results. This study demonstrates that the gas volume of nanobubbles and microbubbles can be reliably measured using headspace GC/MS to validate bubble size measurement techniques. We also conclude that the accuracy of theoretical predictions is highly dependent on proper size and concentration measurements.

Preserving the Integrity of Surfactant-Stabilized Microbubble Membranes for Localized Oxygen Delivery

Ultrasound contrast agents consist of stabilized microbubbles. We are developing a surfactant-stabilized microbubble platform with a shell composed of Span 60 (Sorbitan monostearate) and an emulsifying agent, water-soluble vitamin E (α-tocopheryl poly(ethylene glycol) succinate, abbreviated as TPGS), named SE61. The microbubbles act both as an imaging agent and a vehicle for delivering oxygen to hypoxic areas in tumors. For clinical use, it is important that a platform be stable under storage at room temperature. To accomplish this, a majority of biologicals are prepared as freeze-dried powders, which also eliminates the necessity of a cold chain. The interfaces among the surfactants, gas, and liquids are subject to disruption in both the freezing and drying phases. Using thermocouples to monitor temperature profiles, differential scanning calorimetry to determine the phase transitions, and acoustic properties to gauge the degree of microbubble disruption, the effects of the freezing rate and the addition of different concentrations of lyoprotectants were determined. Slower cooling rates achieved by freezing the samples in a -20 °C bath were found to be reproducible and produce contrast agents with acceptable acoustical properties. The ionic strength of the solutions and the concentration of the lyoprotectant determined the glass-transition temperature (Tg') of the frozen sample, which determines at what temperature samples can be dried without collapse. Crucially, we found that the shelf stability of surfactant-shelled oxygen microbubbles can be enhanced by increasing the lyoprotectant (glucose) concentration from 1.8 to 5.0% (w/v), which prevents the melt temperature (Tm) of the TPGS phase from rising above room temperature. The increase in glucose concentration results in a lowering of Tm of the emulsifying agent, preventing a phase change in the liquid-crystalline phase and allowing for more stable bubbles. We believe that preventing this phase change is necessary to producing stabilized freeze-dried microbubbles.

Nanoparticle-Coated Microbubbles for Combined Ultrasound Imaging and Drug Delivery

Biomedical microbubbles stabilized by a coating of magnetic or drug-containing nanoparticles show great potential for theranostics applications. Nanoparticle-coated microbubbles can be made to be stable, to be echogenic, and to release the cargo of drug-containing nanoparticles with an ultrasound trigger. This Article reviews the design principles of nanoparticle-coated microbubbles for ultrasound imaging and drug delivery, with a particular focus on the physical chemistry of nanoparticle-coated interfaces; the formation, stability, and dynamics of nanoparticle-coated bubbles; and the conditions for controlled nanoparticle release in ultrasound. The emerging understanding of the modes of nanoparticle expulsion and of the transport of expelled material by microbubble-induced flow is paving the way toward more efficient nanoparticle-mediated drug delivery. This Article highlights the knowledge gap that still remains to be addressed before we can control these phenomena.

Mechanistic understanding the bioeffects of ultrasound-driven microbubbles to enhance macromolecule delivery

Ultrasound-driven microbubbles can trigger reversible membrane perforation (sonoporation), open interendothelial junctions and stimulate endocytosis, thereby providing a temporary and reversible time-window for the delivery of macromolecules across biological membranes and endothelial barriers. This time-window is related not only to cavitation events, but also to biological regulatory mechanisms. Mechanistic understanding of the interaction between cavitation events and cells and tissues, as well as the subsequent cellular and molecular responses will lead to new design strategies with improved efficacy and minimized side effects. Recent important progress on the spatiotemporal characteristics of sonoporation, cavitation-induced interendothelial gap and endocytosis, and the spatiotemporal bioeffects and the preliminary biological mechanisms in cavitation-enhanced permeability, has been made. On the basis of the summary of this research progress, this Review outlines the underlying bioeffects and the related biological regulatory mechanisms involved in cavitation-enhanced permeability; provides a critical commentary on the future tasks and directions in this field, including developing a standardized methodology to reveal mechanism-based bioeffects in depth, and designing biology-based treatment strategies to improve efficacy and safety. Such mechanistic understanding the bioeffects that contribute to cavitation-enhanced delivery will accelerate the translation of this approach to the clinic.

Ultra-Low-Dose Ultrasound Molecular Imaging for the Detection of Angiogenesis in a Mouse Murine Tumor Model: How Little Can We See?

OBJECTIVES

The objective of this study was to evaluate the minimum microbubble dose for ultrasound molecular imaging to achieve statistically significant detection of angiogenesis in a mouse model.

MATERIALS AND METHODS

The preburst minus postburst method was implemented on a Verasonics ultrasound research scanner using a multiframe compounding pulse inversion imaging sequence. Biotinylated lipid (distearoyl phosphatidylcholine-based) microbubbles that were conjugated with antivascular endothelial growth factor 2 (VEGFR2) antibody (MBVEGFR2) or isotype control antibody (MBControl) were injected into mice carrying adenocarcinoma xenografts. Different injection doses ranging from 5 × 10 to 1 × 10 microbubbles per mouse were evaluated to determine the minimum diagnostically effective dose.

RESULTS

The proposed imaging sequence was able to achieve statistically significant detection (P < 0.05, n = 5) of VEGFR2 in tumors with a minimum MBVEGFR2 injection dose of only 5 × 10 microbubbles per mouse (distearoyl phosphatidylcholine at 0.053 ng/g mouse body mass). Nonspecific adhesion of MBControl at the same injection dose was negligible. In addition, the targeted contrast ultrasound signal of MBVEGFR2 decreased with lower microbubble doses, whereas nonspecific adhesion of MBControl increased with higher microbubble doses.

CONCLUSIONS

The dose of 5 × 10 microbubbles per animal is now the lowest injection dose on record for ultrasound molecular imaging to achieve statistically significant detection of molecular targets in vivo. Findings in this study provide us with further guidance for future developments of clinically translatable ultrasound molecular imaging applications using a lower dose of microbubbles.

Subharmonic Response of Polymer Contrast Agents Based on the Empirical Mode Decomposition

The subharmonic threshold for ultrasound contrast agents has been defined as a 20-25 dB difference between the fundamental and subharmonic (2/1) spectral components of the backscatter signal. However, this Fourier-based criterion assumes a linear time-invariant signal. A more appropriate criterion for short cycle and frequency-modulated waveforms is proposed with an adaptive signal-processing approach based on the empirical mode decomposition (EMD) method. The signal is decomposed into an orthogonal basis known as intrinsic mode functions (IMFs) and a subharmonic threshold is defined with respect to the energy ratio of the subharmonic IMF component to that of the incident signal. The method is applied to backscatter data acquired from two polymer-shelled contrast agents, Philips (#38, mean diameter 2.0 [Formula: see text]) and Point Biomedical (#12027, mean diameter 3.9 [Formula: see text]). The acoustic backscatter signals are investigated for a single contrast agent subjected to monofrequency (20 MHz, 20 cycles) and chirp (15-25 MHz, 20 cycles) forcing for incident pressures ranging from 0.5 to 2.4 MPa. In comparison to the spectral peak difference (20 dB) criterion, the EMD method is more sensitive in determining subharmonic signals.

Nanobubbles: a promising efficienft tool for therapeutic delivery

In recent decades ultrasound-guided delivery of drugs loaded on nanocarriers has been the focus of increasing attention to improve therapeutic treatments. Ultrasound has often been used in combination with microbubbles, micron-sized spherical gas-filled structures stabilized by a shell, to amplify the biophysical effects of the ultrasonic field. Nanometer size bubbles are defined nanobubbles. They were designed to obtain more efficient drug delivery systems. Indeed, their small sizes allow extravasation from blood vessels into surrounding tissues and ultrasound-targeted site-specific release with minimal invasiveness. Additionally, nanobubbles might be endowed with improved stability and longer residence time in systemic circulation. This review will describe the physico-chemical properties of nanobubbles, the formulation parameters and the drug loading approaches, besides potential applications as a therapeutic tool.

In vivo imaging of microfluidic-produced microbubbles

Microfluidics-based production of stable microbubbles for ultrasound contrast enhancement or drug/gene delivery allows for precise control over microbubble diameter but at the cost of a low production rate. In situ microfluidic production of microbubbles directly in the vasculature may eliminate the necessity for high microbubble production rates, long stability, or small diameters. Towards this goal, we investigated whether microfluidic-produced microbubbles directly administered into a mouse tail vein could provide sufficient ultrasound contrast. Microbubbles composed of nitrogen gas and stabilized with 3 % bovine serum albumin and 10 % dextrose were injected for 10 seconds into wild type C57BL/6 mice, via a tail-vein catheter. Short-axis images of the right and left ventricle were acquired at 12.5 MHz and image intensity over time was analyzed. Microbubbles were produced on the order of 10(5) microbubbles/s and were observed in both the right and left ventricles. The median rise time, duration, and decay time within the right ventricle were 2.9, 21.3, and 14.3 s, respectively. All mice survived the procedure with no observable respiratory or heart rate distress despite microbubble diameters as large as 19 μm.

Ultrasound-based measurement of molecular marker concentration in large blood vessels: a feasibility study

Ultrasound molecular imaging has demonstrated efficacy in pre-clinical studies for cancer and cardiovascular inflammation. However, these techniques often require lengthy protocols because of waiting periods or additional control microbubble injections. Moreover, they are not capable of quantifying molecular marker concentration in human tissue environments that exhibit variable attenuation and propagation path lengths. Our group recently investigated a modulated acoustic radiation force-based imaging sequence, which was found to detect targeted adhesion independent of control measurements. In the present study, this sequence was tested against various experimental parameters to determine its feasibility for quantitative measurements of molecular marker concentration. Results indicated that measurements obtained from the sequence (residual-to-saturation ratio, Rresid) were independent of acoustic pressure and attenuation (p > 0.13, n = 10) when acoustic pressures were sufficiently low. The Rresid parameter exhibited a linear relationship with measured molecular marker concentration (R(2) > 0.94). Consequently, feasibility was illustrated in vitro, for quantification of molecular marker concentration in large vessels using a modulated acoustic radiation force-based sequence. Moreover, these measurements were independent of absolute acoustic reflection amplitude and used short imaging protocols (3 min) without control measurements.

A micrometer-sized ultrasound contrast agent with nanometer-scale polygonal patterning surfaces

PURPOSE

To develop a smaller micro-sized bubble ultrasound contrast agent which composed of an insoluble, less-dense, self-assembled surfactant with a condensed crystallized nanometer-scale polygonal patterning surface.

METHODS

The microbubble was prepared by high-shear mixing a mixture of sucrose esters, glucose sugar, and water. The coulter counter was used to measure the size and concentration of the microbubble. Surface patterns of the microbubble were determined using vitrified samples under cryo-transmission electron microscopy. Myocardial contrast effects of six normal dog's myocardium were assessed.

RESULTS

The diameter of the developed microbubble was smaller than Sonovue(®). Direct imaging of cryo-transmission electron microscopy revealed that the developed microbubble has a nanometer-scale polygonal surface pattern. Both the developed microbubble and Sonovue(®) effectively enhanced the myocardial contrast. The difference in the peak video intensity, the longevity of the contrast effect, and time-to-peak interval between both microbubbles were not statistically significant (NS).

CONCLUSION

The microbubble with nanometer-scale polygonal patterning surfaces is a feasible and promising contrast agent for the ultrasound imaging.

Dynamics of targeted microbubble adhesion under pulsatile compared with steady flow

Hemodynamic flow variations at low fluid shear stress are thought to play a critical role in local atherosclerotic plaque initiation and development and to affect plaque instability. Targeted microbubbles are being developed as intravascular agents for identifying atherosclerotic lesions using ultrasound. How variations in local hydrodynamic flow influence the adhesiveness of targeted microbubbles is not well understood. We postulated that rates of targeted microbubble binding and accumulation differ when subjected to steady flow (SF) as compared with oscillatory or pulsatile flow (PF), because PF imposes non-uniform blood rheology and periodic acceleration and deceleration of blood velocity, when compared with SF. We assessed the binding rates of targeted microbubbles in seven randomly assigned PF and seven matched SF replicate runs at low (<1 Pa) and intermediate (≥1 and <2.5 Pa) wall shear stress (WSS) by drawing 4.8 × 10(6) microbubbles mL(-1) over streptavidin-coated substrates, immobilized within a parallel plate flow chamber at a calculated density of 81 binding sites μm(-2). Selective binding and accumulation of targeted microbubbles was recorded in a single field of view using real-time video microscopy. Microbubble accumulation was modeled to obtain flow-mediated microbubble binding kinetics (amplitude, A, and rate constant, k). PF elicited higher microbubble accumulation rates, in comparison to SF. The rates of microbubble accumulation differed significantly between PF and SF (p < 0.05) at intermediate WSS but not at low WSS (p > 0.05). The rate of microbubble accumulation decreased as WSS increased.

Acoustic behavior of microbubbles and implications for drug delivery

Ultrasound contrast agents are valuable in diagnostic ultrasound imaging, and they increasingly show potential for drug delivery. This review focuses on the acoustic behavior of flexible-coated microbubbles and rigid-coated microcapsules and their contribution to enhanced drug delivery. Phenomena relevant to drug delivery, such as non-spherical oscillations, shear stress, microstreaming, and jetting will be reviewed from both a theoretical and experimental perspective. Further, the two systems for drug delivery, co-administration and the microbubble as drug carrier system, are reviewed in relation to the microbubble behavior. Finally, future prospects are discussed that need to be addressed for ultrasound contrast agents to move from a pre-clinical tool into a clinical setting.

Encapsulated microbubbles and echogenic liposomes for contrast ultrasound imaging and targeted drug delivery

Micron- to nanometer-sized ultrasound agents, like encapsulated microbubbles and echogenic liposomes, are being developed for diagnostic imaging and ultrasound mediated drug/gene delivery. This review provides an overview of the current state of the art of the mathematical models of the acoustic behavior of ultrasound contrast microbubbles. We also present a review of the in vitro experimental characterization of the acoustic properties of microbubble based contrast agents undertaken in our laboratory. The hierarchical two-pronged approach of modeling contrast agents we developed is demonstrated for a lipid coated (Sonazoid™) and a polymer shelled (poly D-L-lactic acid) contrast microbubbles. The acoustic and drug release properties of the newly developed echogenic liposomes are discussed for their use as simultaneous imaging and drug/gene delivery agents. Although echogenicity is conclusively demonstrated in experiments, its physical mechanisms remain uncertain. Addressing questions raised here will accelerate further development and eventual clinical approval of these novel technologies.

Cavitation thresholds of contrast agents in an in vitro human clot model exposed to 120-kHz ultrasound

Ultrasound contrast agents (UCAs) can be employed to nucleate cavitation to achieve desired bioeffects, such as thrombolysis, in therapeutic ultrasound applications. Effective methods of enhancing thrombolysis with ultrasound have been examined at low frequencies (<1 MHz) and low amplitudes (<0.5 MPa). The objective of this study was to determine cavitation thresholds for two UCAs exposed to 120-kHz ultrasound. A commercial ultrasound contrast agent (Definity(®)) and echogenic liposomes were investigated to determine the acoustic pressure threshold for ultraharmonic (UH) and broadband (BB) generation using an in vitro flow model perfused with human plasma. Cavitation emissions were detected using two passive receivers over a narrow frequency bandwidth (540-900 kHz) and a broad frequency bandwidth (0.54-1.74 MHz). UH and BB cavitation thresholds occurred at the same acoustic pressure (0.3 ± 0.1 MPa, peak to peak) and were found to depend on the sensitivity of the cavitation detector but not on the nucleating contrast agent or ultrasound duty cycle.

Synthesis and characterization of transiently stable albumin-coated microbubbles via a flow-focusing microfluidic device

We describe a method for synthesizing albumin-shelled, large-diameter (>10 μm), transiently stable microbubbles using a flow-focusing microfluidic device (FFMD). The microfluidic device enables microbubbles to be produced immediately before insonation, thus relaxing the requirements for stability. Both reconstituted fractionated bovine serum albumin (BSA) and fresh bovine blood plasma were investigated as shell stabilizers. Microbubble coalescence was inhibited by the addition of either dextrose or glycerol and propylene glycol. Microbubbles were observed to have an acoustic half-life of approximately 6 s. Microbubbles generated directly within a vessel phantom containing flowing blood produced a 6.5-dB increase in acoustic signal within the lumen. Microbubbles generated in real time upstream of in vitro rat aortic smooth muscle cells under physiologic flow conditions successfully permeabilized 58% of the cells on insonation at a peak negative pressure of 200 kPa. These results indicate that transiently stable microbubbles produced via flow-focusing microfluidic devices are capable of image enhancement and drug delivery. In addition, successful microbubble production with blood plasma suggests the potential to use blood as a stabilizing shell.

Treatment of murine tumors using acoustic droplet vaporization-enhanced high intensity focused ultrasound

High intensity focused ultrasound (HIFU) can be applied focally and noninvasively to thermally ablate solid tumors. Long treatment times are typically required for large tumors, which can expose patients to certain risks while potentially decreasing the therapeutic efficacy of the treatment. Acoustic droplet vaporization (ADV) is a promising modality that can enhance the efficacy of tumor treatment using HIFU. In this study, the therapeutic effects of combined HIFU and ADV was evaluated in mice bearing subcutaneously-implanted 4T1 tumors. Histological examination showed that the combination of HIFU and ADV generated a mean necrotic area in the tumor that was 2.9-fold larger than with HIFU alone. A significant enhancement of necrosis was found in the periphery of the tumor, where the blood supply was abundant. Seven days after treatment, the tumors treated with combined HIFU and ADV were 30-fold smaller in volume than tumors treated with HIFU alone. The study demonstrates the potential advantage of combining HIFU and ADV in tumor treatment.

The response of phospholipid-encapsulated microbubbles to chirp-coded excitation: implications for high-frequency nonlinear imaging

The current excitation strategy for harmonic and subharmonic imaging (HI and SHI) uses short sine-bursts. However, alternate pulsing strategies may be useful for enhancing nonlinear emissions from ultrasound contrast agents. The goal of this study was to corroborate the hypothesis that chirp-coded excitation can improve the performance of high-frequency HI and SHI. A secondary goal was to understand the mechanisms that govern the response of ultrasound contrast agents to chirp-coded and sine-burst excitation schemes. Numerical simulations and acoustic measurements were conducted to evaluate the response of a commercial contrast agent (Targestar-P(®)) to chirp-coded and sine-burst excitation (10 MHz frequency, peak pressures 290 kPa). The results of the acoustic measurements revealed an improvement in signal-to-noise ratio by 4 to 14 dB, and a two- to threefold reduction in the subharmonic threshold with chirp-coded excitation. Simulations conducted with the Marmottant model suggest that an increase in expansion-dominated radial excursion of microbubbles was the mechanism responsible for the stronger nonlinear response. Additionally, chirp-coded excitation detected the nonlinear response for a wider range of agent concentrations than sine-bursts. Therefore, chirp-coded excitation could be a viable approach for enhancing the performance of HI and SHI.

Liquid Flooded Flow-Focusing Microfluidic Device for in situ Generation of Monodisperse Microbubbles

Current microbubble-based ultrasound contrast agents are administered intravenously resulting in large losses of contrast agent, systemic distribution, and strict requirements for microbubble longevity and diameter size. Instead we propose in situ production of microbubbles directly within the vasculature to avoid these limitations. Flow focusing microfluidic devices (FFMDs) are a promising technology for enabling in situ production as they can produce microbubbles with precisely controlled diameters in real-time. While the microfluidic chips are small, the addition of inlets and interconnects to supply the gas and liquid phase greatly increases the footprint of these devices preventing the miniaturization of FFMDs to sizes compatible with medium and small vessels. To overcome this challenge, we introduce a new method for supplying the liquid (shell) phase to an FFMD that eliminates bulky interconnects. A pressurized liquid-filled chamber is coupled to the liquid inlets of an FFMD, which we term a flooded FFMD. The microbubble diameter and production rate of flooded FFMDs were measured optically over a range of gas pressures and liquid flow rates. The smallest FFMD manufactured measured 14.5 × 2.8 × 2.3 mm. A minimum microbubble diameter of 8.1 ± 0.3 μm was achieved at a production rate of 450,000 microbubbles/s (MB/s). This represents a significant improvement with respect to any previously reported result. The flooded design also simplifies parallelization and production rates of up to 670,000 MB/s were achieved using a parallelized version of the flooded FFMD. In addition, an intravascular ultrasound (IVUS) catheter was coupled to the flooded FFMD to produce an integrated ultrasound contrast imaging device. B-mode and IVUS images of microbubbles produced from a flooded FFMD in a gelatin phantom vessel were acquired to demonstrate the potential of in situ microbubble production and real-time imaging. Microbubble production rates of 222,000 MB/s from a flooded FFMD within the vessel lumen provided a 23 dB increase in B-mode contrast. Overall, the flooded design is a critical contribution towards the long- term goal of utilizing in situ produced microbubbles for contrast enhanced ultrasound imaging of, and drug delivery to, the vasculature.

Production rate and diameter analysis of spherical monodisperse microbubbles from two-dimensional, expanding-nozzle flow-focusing microfluidic devices

Flow-focusing microfluidic devices (FFMDs) can produce microbubbles (MBs) with precisely controlled diameters and a narrow size distribution. In this paper, poly-dimethyl-siloxane based, rectangular-nozzle, two-dimensional (2-D) planar, expanding-nozzle FFMDs were characterized using a high speed camera to determine the production rate and diameter of Tween 20 (2% v/v) stabilized MBs. The effect of gas pressure and liquid flow rate on MB production rate and diameter was analyzed in order to develop a relationship between FFMD input parameters and MB production. MB generation was observed to transition through five regimes at a constant gas pressure and increasing liquid flow rate. Each MB generation event (i.e., break-off to break-off) was further separated into two characteristic phases: bubbling and waiting. The duration of the bubbling phase was linearly related to the liquid flow rate, while the duration of the waiting phase was related to both liquid flow rate and gas pressure. The MB production rate was found to be inversely proportional to the sum of the bubbling and waiting times, while the diameter was found to be proportional to the product of the gas pressure and bubbling time.

Phospholipid/Carbocyanine Dye-Shelled Microbubbles as Ultrasound-Modulated Fluorescent Contrast Agents

Fluorescent microbubbles have been fabricated with the capacity to have their emission modulated by ultrasound. These contrast agent particles could potentially be used in the future to extract fluorescence modulation from a strong light background to increase imaging depth and resolution in scattering media. Fluorescence intensity modulation was demonstrated at the ultrasound driving frequency.

Quantitation of MRI sensitivity to quasi-monodisperse microbubble contrast agents for spatially resolved manometry

PURPOSE

The direct in-vivo measurement of fluid pressure cannot be achieved with MRI unless it is done with the contribution of a contrast agent. No such contrast agents are currently available commercially, whilst those demonstrated previously only produced qualitative results due to their broad size distribution. Our aim is to quantitate then model the MR sensitivity to the presence of quasi-monodisperse microbubble populations.

METHODS

Lipid stabilised microbubble populations with mean radius 1.2 ± 0.8 μm have been produced by mechanical agitation. Contrast agents with increasing volume fraction of bubbles up to 4% were formed and the contribution the bubbles bring to the relaxation rate was quantitated. A periodic pressure change was also continuously applied to the same contrast agent, until MR signal changes were only due to bubble radius change and not due to a change in bubble density.

RESULTS

The MR data compared favourably with the prediction of an improved numerical simulation. An excellent MR sensitivity of 23 % bar(-1) has been demonstrated.

CONCLUSION

This work opens up the possibility of generating microbubble preparations tailored to specific applications with optimised MR sensitivity, in particular MRI based in-vivo manometry.

Gauging the likelihood of stable cavitation from ultrasound contrast agents

The mechanical index (MI) was formulated to gauge the likelihood of adverse bioeffects from inertial cavitation. However, the MI formulation did not consider bubble activity from stable cavitation. This type of bubble activity can be readily nucleated from ultrasound contrast agents (UCAs) and has the potential to promote beneficial bioeffects. Here, the presence of stable cavitation is determined numerically by tracking the onset of subharmonic oscillations within a population of bubbles for frequencies up to 7 MHz and peak rarefactional pressures up to 3 MPa. In addition, the acoustic pressure rupture threshold of an UCA population was determined using the Marmottant model. The threshold for subharmonic emissions of optimally sized bubbles was found to be lower than the inertial cavitation threshold for all frequencies studied. The rupture thresholds of optimally sized UCAs were found to be lower than the threshold for subharmonic emissions for either single cycle or steady state acoustic excitations. Because the thresholds of both subharmonic emissions and UCA rupture are linearly dependent on frequency, an index of the form I(CAV) = P(r)/f (where P(r) is the peak rarefactional pressure in MPa and f is the frequency in MHz) was derived to gauge the likelihood of subharmonic emissions due to stable cavitation activity nucleated from UCAs.

In vivo characterization of ultrasound contrast agents: microbubble spectroscopy in a chicken embryo

The dynamics of coated microbubbles was studied in an in vivo model. Biotinylated lipid-coated microbubbles were prepared in-house and were injected into a chick embryo chorioallantoic membrane (CAM) model on the fifth day of incubation. The microbubbles, ranging between 1.0 and 3.5 μm in diameter, were insonified in the frequency range of 4-7 MHz. Two amplitudes of acoustic pressure were applied: 300 kPa and 400 kPa. The fundamental and subharmonic responses were recorded optically with an ultra-fast camera (Brandaris 128) at 20 million frames per second. A subharmonic response was observed for 44% of the studied bubbles. From the data the frequency of the maximum fundamental and subharmonic response was derived for each individual bubble and resulted in the resonance curves of the microbubbles. All the bubbles showed shell (strain) hardening behavior for a higher acoustic pressure. We conclude that the subharmonic oscillations observed in this study belonged to the transmit at resonance (TR) regime.

Model for bubble pulsation in liquid between parallel viscoelastic layers

A model is presented for a pulsating spherical bubble positioned at a fixed location in a viscous, compressible liquid between parallel viscoelastic layers of finite thickness. The Green's function for particle displacement is found and utilized to derive an expression for the radiation load imposed on the bubble by the layers. Although the radiation load is derived for linear harmonic motion it may be incorporated into an equation for the nonlinear radial dynamics of the bubble. This expression is valid if the strain magnitudes in the viscoelastic layer remain small. Dependence of bubble pulsation on the viscoelastic and geometric parameters of the layers is demonstrated through numerical simulations.

Magnetically enhanced nucleic acid delivery. Ten years of magnetofection-progress and prospects

Nucleic acids carry the building plans of living systems. As such, they can be exploited to make cells produce a desired protein, or to shut down the expression of endogenous genes or even to repair defective genes. Hence, nucleic acids are unique substances for research and therapy. To exploit their potential, they need to be delivered into cells which can be a challenging task in many respects. During the last decade, nanomagnetic methods for delivering and targeting nucleic acids have been developed, methods which are often referred to as magnetofection. In this review we summarize the progress and achievements in this field of research. We discuss magnetic formulations of vectors for nucleic acid delivery and their characterization, mechanisms of magnetofection, and the application of magnetofection in viral and nonviral nucleic acid delivery in cell culture and in animal models. We summarize results that have been obtained with using magnetofection in basic research and in preclinical animal models. Finally, we describe some of our recent work and end with some conclusions and perspectives.

Stabilization of Gas Bubbles Released from Water-Soluble Carbohydrates Using Amphiphilic Compounds: Preparation of Formulations and Acoustic Monitoring of Bubble Lifetime

The ultrasound contrast agents Echovist^® and Levovist^® (Bayer AG, Schering AG, Germany) are based on the release of gas bubbles from milled α-d-galactose. In diagnostic ultrasound, for this class of contrast agents, there is a need for prolonged contrast duration. To investigate if new carbohydrate compositions could prolong the lifetime of the gas bubbles, α-d-galactose was mixed with other carbohydrates or amphiphiles with varying log P. Acoustic attenuation vs. time (390 s) area under the curve (A₃₉₀) and bubble half-time (t½) were used as measures of prolonged lifetime of gas bubbles. The products, to which 0.1% of a lipophilic carboxylic acid (5β-cholanic acid, behenic acid, and melissic acid) has been added, showed more than 5, 7 and 11 times enhancement of A₃₉₀, respectively, compared with the reference compound 2 (RC2) corresponding to the commercial product Levovist®. The half-time t ½ of the same compounds was prolonged more than 6 times compared with RC2. A partial least square (PLS) statistical analysis confirmed that, for additives, high log P carboxylic acids lead to the highest A₃₉₀. The present results bear a promise of products with a more persistent in vivo ultrasound contrast effect than the commercially available agents.

Bench-to-bedside review: contrast enhanced ultrasonography--a promising technique to assess renal perfusion in the ICU

Acute kidney injury (AKI) is common in critically ill patients and associated with important morbidity and mortality. Although alterations in renal perfusion are thought to play a causative role in the pathogenesis of AKI, there is, to date, no reliable technique that allows the assessment of renal perfusion that is applicable in the ICU. Contrast-enhanced ultrasound (CEUS) is an ultrasound imaging technique that makes use of microbubble-based contrast agents. These microbubbles, when injected into the bloodstream, allow visualization of vascular structures and, with contrast-specific imaging modes, detection of blood flow at the capillary level. Some recent CEUS-derived approaches allow quantification of blood flow in several organs, including the kidney. Current generation ultrasound contrast agents have strong stability and safety profiles. Along with post-marketing surveillance, numerous studies report safe administration of these agents, including in critically ill patients. This review presents information on the physical principles underlying CEUS, the methods allowing blood flow quantification and the potential applications of CEUS in critical care nephrology, currently as a research tool but perhaps in the future as a way of monitoring renal perfusion.

Buckling resistance of solid shell bubbles under ultrasound

Thin solid shell contrast agents bubbles are expected to undergo different volume oscillating behaviors when the acoustic power is increased: small oscillations when the shell remains spherical, and large oscillations when the shell buckles. Contrary to bubbles covered with thin lipidic monolayers that buckle as soon as compressed: the solid shell bubbles resist compression, making the buckling transition abrupt. Numerical simulations that explicitly incorporate a shell bending modulus give the critical buckling pressure and post-buckling shape, and show the appearance of a finite number of wrinkles. These findings are incorporated in a model based on the concept of effective surface tension. This model compares favorably to experiments when adjusting two main parameters: the buckling tension and the rupture shell tension. The buckling tension provides a direct estimation of the acoustic pressure threshold at which buckling occurs.

Advances in molecular imaging with ultrasound

Ultrasound imaging has long demonstrated utility in the study and measurement of anatomic features and noninvasive observation of blood flow. Within the last decade, advances in molecular biology and contrast agents have allowed researchers to use ultrasound to detect changes in the expression of molecular markers on the vascular endothelium and other intravascular targets. This new technology, referred to as ultrasonic molecular imaging, is still in its infancy. However, in preclinical studies, ultrasonic molecular imaging has shown promise in assessing angiogenesis, inflammation, and thrombus. In this review, we discuss recent advances in microbubble-type contrast agent development, ultrasound technology, and signal processing strategies that have the potential to substantially improve the capabilities and utility of ultrasonic molecular imaging.

Hollow spherical nanoparticulate aggregates as potential ultrasound contrast agent: shell thickness characterization

OBJECTIVE

The objective of this work is to manufacture hollow spherical nanoparticulate aggregates for use as an ultrasound contrast agent by means of spray drying of nanoparticulate suspension at a fast drying rate.

METHODOLOGY

Biocompatible PMMA-MeOPEGMA and silica nanoparticles are used as the model nanoparticles. The impacts of changing the nanoparticle concentration, pH, and spray drying operating condition on the size and shell thickness-to-particle radius (S/R) ratio, which governs the shell mechanical stability, are investigated.

RESULTS AND CONCLUSION

The results indicate that the hollow microspheres size varies between 2 and 10 mum having S/R ratio between 2% and 4%, where the smaller size particles exhibit a higher S/R ratio. The resultant S/R ratio is found to be more influenced by process parameters acting at the nanoparticle scale (e.g., suspension pH) than by the spray drying operating condition.

Acoustic measurement of bubble size in an inkjet printhead

The volume of a bubble in a piezoinkjet printhead is measured acoustically. The method is based on a numerical model of the investigated system. The piezo not only drives the system but it is also used as a sensor by measuring the current it generates. The numerical model is used to predict this current for a given bubble volume. The inverse problem is to infer the bubble volume from an experimentally obtained piezocurrent. By solving this inverse problem, the size and position of the bubble can thus be measured acoustically. The method is experimentally validated with an inkjet printhead that is augmented with a glass connection channel, through which the bubble was observed optically, while at the same time the piezocurrent was measured. The results from the acoustical measurement method correspond closely to the results from the optical measurement.

Heat enhances gas delivery and acoustic attenuation in CO(2) filled microbubbles

Thermo-responsive chitosan microbubbles were developed as new therapeutic device for vehiculating gases to tissues concomitantly to hyperthermic treatments. Aiming at applications to non-invasive temperature monitoring, microbubbles were characterized for acoustic attenuation properties in the 1-15 MHz range both by direct methods and by B-mode Ultrasound imaging up to 43 degrees C, which is the temperature used in clinical hyperthermia. The chitosan microbubbles showed a mean diameter of 1 microm at room temperature, which slightly decreases after heating, enhancing gas delivery. Acoustic attenuation monotonically increases with temperature, being the extent of such variation larger than that observed in tissues. Both the physico-chemical and the acoustic profiles showed reversible variations of microbubbles approaching 43 degrees C, which might be of interest for applications in hyperthermic therapies.

Chirp excitation technique to enhance microbubble displacement induced by ultrasound radiation force

Ultrasound radiation force has been proposed to increase the targeting efficiency in ultrasonic molecular imaging and drug delivery. A chirp excitation technique is proposed to increase the radiation force induced microbubble displacement and might potentially be used for enhancing the targeting efficiency of microbubble clouds. In this study, a modified Rayleigh-Plesset equation is used to estimate the radius-time behavior of insonified microbubbles, and the translation of insonified microbubbles is calculated by using the particle trajectory equation. Simulations demonstrate that the chirp excitation is superior to the sinusoidal one in displacing microbubbles with a wide-size distribution, and that the performance is dependent on the parameters of the chirp signal such as the center frequency and frequency range. For Gaussian size distributed microbubble clouds with mean diameter of 3.5 microm and variance of 1, a 2.25 MHz chirp with frequency range of 1.5 MHz induces about 59.59% more microbubbles over a distance of 10 microm during 200 micros insonification, compared to a 2.25 MHz sinusoidal excitation with equal acoustic pressure.

Nonspherical oscillations of ultrasound contrast agent microbubbles

The occurrence of nonspherical oscillations (or surface modes) of coated microbubbles, used as ultrasound contrast agents in medical imaging, is investigated using ultra-high-speed optical imaging. Optical tweezers designed to micromanipulate single bubbles in 3-D are used to trap the bubbles far from any boundary, enabling a controlled study of the nonspherical oscillations of free-floating bubbles. Nonspherical oscillations appear as a parametric instability and display subharmonic behavior: they oscillate at half the forcing frequency, which was fixed at 1.7 MHz in this study. Surface modes are shown to preferentially develop for a bubble radius near the resonance of radial oscillations. In the studied range of acoustic pressures, the growth of surface modes saturates at a level far below bubble breakage. With the definition of a single, dimensionless deformation parameter, the amplitude of nonspherical deformation is quantified as a function of the bubble radius (between 1.5 and 5 microm) and of the acoustic pressure (up to 200 kPa).

In vitro characterization of the subharmonic ultrasound signal from Definity microbubbles at high frequencies

Ultrasound microbubble contrast agents have been demonstrated to scatter subharmonic energy at one-half the driving frequency. At ultrasound frequencies in the 20-40 MHz range, the subharmonic offers the potential to differentiate the blood in the microcirculation from the surrounding tissue. It is unknown whether current contrast agents, manufactured to be resonant between 2 and 12 MHz, are ideal for subharmonic imaging at higher frequencies. We performed numerical simulations of the Keller-Miksis model for the behavior of a single bubble and experimental investigations of Definity microbubbles in water. The results supported the hypothesis that off-resonant bubbles, excited at their second harmonic, may be primarily responsible for the observed subharmonic energy. For frequencies between 20 and 32 MHz and 32 and 40 MHz, the optimal bubble diameters for the generation of subharmonics in vitro were determined experimentally to be 1.2-5 microm and less than 1.2 microm, respectively. Definity may be a suitable ultrasound contrast agent for subharmonic imaging at 20 MHz with peak-negative pressures between 380 and 590 kPa and pulses greater than or equal to four cycles in duration.

Ultrasound-driven microbubble oscillation and translation within small phantom vessels

The use of ultrasound radiation force to manipulate microbubbles in blood vessels has attracted recent interest as a method to increase the efficiency of ultrasonic molecular imaging and drug delivery. However, recent studies indicate that microbubble oscillation is diminished within small blood vessels, and therefore we investigate microbubble oscillation and translation within 12 microm vessels using high-speed photography. With each 0.1- to 1-MPa ultrasound pulse, microbubbles (radius of 1, 1.5 and 2 microm) within 12 microm tubes translate 5 to 10 times less than those within 200 microm tubes. Application of a pulse train with a high pulse repetition frequency displaces bubbles to the wall of 12- and 200-microm tubes within an interval ( approximately 1 s) that is reasonable for clinical translation. Modeling of coupled oscillation and translation for unconstrained microbubbles, based on a modified Rayleigh-Plesset (RP) and the trajectory equations, is compared with experimental observations and demonstrates agreement for the larger displacements observed within the 200 microm tubes. This study has implications for contrast-assisted ultrasound applications, aiding the manipulation of targeted microbubbles and for further theoretical understanding of the complex bubble dynamics within constrained vessel.

The application of microbubbles for targeted drug delivery

Interest in microbubbles as vehicles for drug delivery has grown in recent years, due in part to characteristics that make them well suited for this role and in part to the need the for localized delivery of drugs in a number of applications. Microbubbles are inherently small, allowing transvascular passage, they can be functionalized for targeted adhesion, and can be acoustically driven, which facilitates ultrasound detection, production of bioeffects and controlled release of the cargo. This article provides an overview of related microbubble biofluid mechanics and reviews recent developments in the application of microbubbles for targeted drug delivery. Additionally, related advances in non-bubble microparticles for drug delivery are briefly described in the context of targeted adhesion.

Enhancement of subharmonic emission from encapsulated microbubbles by using a chirp excitation technique

Subharmonic contrast imaging promises to improve ultrasound-imaging quality by taking advantage of an increased contrast to tissue signal. However, acoustic pressures beyond the subharmonic generation threshold using common ultrasound pulses may induce significant contrast microbubble destruction. In this work, a chirp excitation technique is presented to enhance the subharmonic emission from encapsulated microbubbles. Chirp signals with a center frequency of 5 MHz, variable frequency range and duration time are employed to drive microbubbles in numerical simulation and experimental studies. We provide a theoretical evaluation of the chirp excitation pressure threshold and the acoustic pressure dependence of subharmonic based on Church's model and demonstrate that the amplitude and axial resolution of the subharmonic can be optimized by proper selection of the frequency range and time duration of the chirp signal. Measurements are qualitatively in agreement with the simulation. Moreover, we demonstrate that chirp excitation may be able to improve the amplitude of the subharmonic component up to 22 dB over the pulse excitation. The chirp excitation technique could potentially be used for improving the subharmonic contrast imaging quality.

Microbubble spectroscopy of ultrasound contrast agents

A new optical characterization of the behavior of single ultrasound contrast bubbles is presented. The method consists of insonifying individual bubbles several times successively sweeping the applied frequency, and to record movies of the bubble response up to 25 million frames/s with an ultrahigh speed camera operated in a segmented mode. The method, termed microbubble spectroscopy, enables to reconstruct a resonance curve in a single run. The data is analyzed through a linearized model for coated bubbles. The results confirm the significant influence of the shell on the bubble dynamics: shell elasticity increases the resonance frequency by about 50%, and shell viscosity is responsible for about 70% of the total damping. The obtained value for shell elasticity is in quantative agreement with previously reported values. The shell viscosity increases significantly with the radius, revealing a new nonlinear behavior of the phospholipid coating.