An in vitro comparison of ultrasonic contrast agents in solutions with varying air levels

Resolving Ultrasound Contrast Microbubbles Using Minimum Variance Beamforming

Minimum Variance (MV) beamforming is known to improve the lateral resolution of ultrasound images and enhance the separation of isolated point scatterers. This paper aims to evaluate the adaptive beamformer's performance with flowing microbubbles (MBs) which are relevant to super-resolution ultrasound imaging. Simulations using point scatterer data from single emissions were complemented by an experimental investigation performed using a capillary tube phantom and the Synthetic Aperture Real-time Ultrasound System (SARUS). The MV performance was assessed by the minimum distance that allows the display of two scatterers positioned side-by-side, the lateral Full-Width-at-Half-Maximum (FWHM), and the Peak-Sidelobe-Level (PSL). In the tube, scatterer responses separated by down to [Formula: see text] (or 1.05λ ) were distinguished by the MV method, while the standard Delay-And-Sum (DAS) beamformers were unable to achieve such separation. Up to ninefold FWHM decrease was also measured in favor of the MV beamformer for individual echoes from MBs. The lateral distance between two scatterers impacted on their FWHM value, and additional differences in the scatterers' axial or out-of-plane position also impacted on their size and appearance. The simulation and experimental results were in agreement in terms of lateral resolution. The point scatterer study showed that the proposed MV imaging scheme provided clear resolution benefits compared to DAS. Current super-resolution methods mainly depend on DAS beamformers. Instead, the use of the MV method may provide a larger number of detected, and potentially better localized, MB scatterers.

Characterization of Contrast Agent Microbubbles for Ultrasound Imaging and Therapy Research

The high efficiency with which gas microbubbles can scatter ultrasound compared with the surrounding blood pool or tissues has led to their widespread employment as contrast agents in ultrasound imaging. In recent years, their applications have been extended to include super-resolution imaging and the stimulation of localized bio-effects for therapy. The growing exploitation of contrast agents in ultrasound and in particular these recent developments have amplified the need to characterize and fully understand microbubble behavior. The aim in doing so is to more fully exploit their utility for both diagnostic imaging and potential future therapeutic applications. This paper presents the key characteristics of microbubbles that determine their efficacy in diagnostic and therapeutic applications and the corresponding techniques for their measurement. In each case, we have presented information regarding the methods available and their respective strengths and limitations, with the aim of presenting information relevant to the selection of appropriate characterization methods. First, we examine methods for determining the physical properties of microbubble suspensions and then techniques for acoustic characterization of both suspensions and single microbubbles. The next section covers characterization of microbubbles as therapeutic agents, including as drug carriers for which detailed understanding of their surface characteristics and drug loading capacity is required. Finally, we discuss the attempts that have been made to allow comparison across the methods employed by various groups to characterize and describe their microbubble suspensions and promote wider discussion and comparison of microbubble behavior.

A primer on the methods and applications for contrast echocardiography in clinical imaging

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.

Stability of echogenic liposomes as a blood pool ultrasound contrast agent in a physiologic flow phantom

Echogenic liposomes (ELIP) are multifunctional ultrasound contrast agents (UCAs) with a lipid shell encapsulating both air and an aqueous core. ELIP are being developed for molecular imaging and image-guided therapeutic delivery. Stability of the echogenicity of ELIP in physiologic conditions is crucial to their successful translation to clinical use. In this study, we determined the effects of the surrounding media's dissolved air concentration, temperature transition and hydrodynamic pressure on the echogenicity of a chemically modified formulation of ELIP to promote stability and echogenicity. ELIP samples were diluted in porcine plasma or whole blood and pumped through a pulsatile flow system with adjustable hydrodynamic pressures and temperature. B-mode images were acquired using a clinical diagnostic scanner every 5 s for a total duration of 75 s. Echogenicity in porcine plasma was assessed as a function of total dissolved gas saturation. ELIP were added to plasma at room temperature (22 °C) or body temperature (37 °C) and pumped through a system maintained at 22 °C or 37 °C to study the effect of temperature transitions on ELIP echogenicity. Echogenicity at normotensive (120/80 mmHg) and hypertensive pressures (145/90 mmHg) was measured. ELIP were echogenic in plasma and whole blood at body temperature under normotensive to hypertensive pressures. Warming of samples from room temperature to body temperature did not alter echogenicity. However, in plasma cooled rapidly from body temperature to room temperature or in degassed plasma, ELIP lost echogenicity within 20 s at 120/80 mmHg. The stability of echogenicity of a modified ELIP formulation was determined in vitro at body temperature, physiologic gas concentration and throughout the physiologic pressure range. However, proper care should be taken to ensure that ELIP are not cooled rapidly from body temperature to room temperature as they will lose their echogenic properties. Further in vivo investigations will be needed to evaluate the optimal usage of ELIP as blood pool contrast agents.

The assessment of microvascular flow and tissue perfusion using ultrasound imaging

Imaging microvascular flow is of diagnostic value for a wide range of diseases including cancer, inflammation, and cardiovascular disease. The introduction of microbubbles as ultrasound contrast agents offers significant signal enhancement to the otherwise weakly scattered signal from blood in the circulation. Microbubbles provide maximum impedance mismatch, but are not linear scatterers. Their complex response to ultrasound has generated research on both their behaviour and their scattered-signal processing. Nearly 20 years ago signal processing started with simple spectral filtering of harmonics showing contrast-enhanced images. More recent pulse encoding techniques have achieved good cancellation of tissue echoes. The good quality contrast-only images enabled ultrasound contrast-imaging applications to be established in microvascular measurements in the liver and the myocardium. The field promises to advance the quantification of microvascular flow kinetics.

An approximate nonlinear model for time gain compensation of amplitude modulated images of ultrasound contrast agent perfusion

Microbubble ultrasound contrast agents allow blood perfusion to be imaged at the cost of an increased attenuation that is not properly handled by existing time gain compensation methods. An automatic TGC has been developed that is able to account for different microbubble concentrations. The technique is an extension of a previously tested approach for modeling the nonlinear dependence of microbubble backscattering upon insonating pressure. The proposed method involves modeling in amplitude of the nonlinear attenuation for both forward and backward propagation, and the solution is achieved through an approximation set to overestimate the attenuation. The resulting equations are used to model and compensate amplitude modulation (AM) images; they are tested on radiofrequency data acquired using a clinical scanner from a gelatin tissue-mimicking phantom submerged in a contrast agent solution in the 0.08 MI to 0.51 MI range at 2 MHz. The nonlinear estimation equation presented here provides a significantly improved amplification profile compared with standard TGC algorithms, resulting in more accurate attenuation correction of the AM image.

Response of contrast agents to ultrasound

Microbubbles are used as ultrasonic contrast agents that enhance the ultrasound signals of the vascular bed. The recent development of site-targeted microbubbles opened up the possibility for molecular imaging as well as localised drug and gene delivery. Initially the microbubbles' physical properties and their response to the ultrasound beam were not fully understood. However, the introduction of fast acquisition microscopy has allowed the observation of the microbubble behaviour in the presence of ultrasound. In addition, acoustical techniques can determine the scatter of single microbubbles. Sonoporation experiments promise high-specificity drug and gene delivery, but the responsible physical mechanisms, particularly for in vivo applications, are not fully understood. An improvement of microbubble technology may address variability related problems in both imaging and drug/gene delivery.

Air microbubbles as MR susceptibility contrast agent at 1.5 Tesla

Air microbubbles have been investigated recently at high magnetic field strength (2 Tesla or greater) as potential MR susceptibility contrast agents. We used a phantom to measure their susceptibility at 1.5 T to clarify their usefulness for this purpose. The phantom, filled with fresh Levovist suspension at 4 different doses (67 to 125 mg/mL), was continuously scanned with a gradient-echo technique at a temporal resolution of 10 s. The transverse relaxation increase (R2*) by microbubbles demonstrated a time course of exponential decay at each dose (time-constant, 39 to 57 s). The dependency of R2* on microbubble volume fraction was linear, with a slope of 89 s-1 per percentage microbubble volume fraction. Our study represents the first step towards applying microbubbles as susceptibility contrast agents at 1.5 T.

Contrast echocardiography

Myocardial contrast echocardiography (MCE) is a noninvasive imaging technique that relies on the ultrasound detection of microbubble contrast agents. These agents are confined to the intravascular space thereby producing signal enhancement from the blood pool. This review encompasses many of the key concepts regarding the clinical application of MCE. The first section focuses on the composition, safety, and biokinetics of ultrasound contrast agents. Then we discuss new ultrasound imaging methodology that has been developed to enhance detection of contrast agent and to assess perfusion at the tissue level. Next, the clinical applications of contrast ultrasound are reviewed. These include enhancement of the cardiac chambers for better assessment of cardiac function and masses, myocardial perfusion imaging for the detection of coronary artery disease, and the assessment of myocardial viability and microvascular reflow. Finally, we discuss some of the future applications for MCE, which include molecular imaging of disease and drug/gene delivery. The overall aim of the review is to update the clinician on state-of-the-art MCE and how it can be applied in patients with cardiovascular disease.

The behaviour of individual contrast agent microbubbles

In recent years, our knowledge of the behaviour of ultrasonic microbubble contrast agents has improved substantially through in vitro experiments. However, there has been a tendency to use high concentrations of contrast agents in suspension, so that ultrasonic backscatter data are generated by a cloud of microbubbles. Such experiments involve a variety of assumptions with validity that is open to question. In addition, high concentrations of microbubbles cannot be used to understand the behaviour of individual microbubble scatterers. This paper proposes a technique that minimises the number of assumptions that need to be made to interpret in vitro experimental data. The basis of the technique is a dilute suspension of microbubbles that makes single scattering events distinguishable. A commercial scanner was used to collect radio frequency (RF) data from suspensions of two different contrast agents, Quantison and Definity. Backscatter data were collected over a range of acoustic pressures. It was found that Definity provided a constant number of scattering events per unit volume of suspension for almost all applied acoustic pressures. Quantison demonstrated an increasing number of scattering events per unit volume with increasing acoustic pressure. Below 0.6 MPa, Quantison scatterers were not individually detectable and provided levels of backscatter similar to those of a blood-mimicking fluid, which suggests that Quantison microbubbles had almost linear scattering behaviour. At acoustic pressures greater than 0.6 MPa, both agents appeared to provide echoes from free bubbles. The change in the number of scatterers per unit volume with acoustic pressure cannot be demonstrated using high concentrations of contrast agent.

Second harmonic imaging: a new ultrasound technique to assess human brain tumour perfusion

BACKGROUND

Second harmonic imaging is a new ultrasound technique that allows evaluation of brain tissue perfusion after application of an ultrasound contrast agent.

OBJECTIVE

To evaluate the potential of this technique for the assessment of abnormal echo contrast characteristics of different brain tumours.

METHODS

27 patients with brain tumours were studied. These were divided into four groups: gliomas, WHO grade III-IV (n = 6); meningiomas (n = 9); metastases (n = 5); and others (n = 7). Patients were examined by second harmonic imaging in a transverse axial insonation plane using the transtemporal approach. Following intravenous administration of 4 g (400 mg/ml) of a galactose based echo contrast agent, 62 time triggered images (one image per 2.5 seconds) were recorded and analysed off-line. Time-intensity curves of two regions of interest (tumour tissue and healthy brain tissue), including peak intensity (PI) (dB), time to peak intensity (TP) (s), and positive gradient (PG) (dB/s), as well as ratios of the peak intensities of the two regions of interest, were derived from the data and compared intraindividually and interindividually.

RESULTS

After administration of the contrast agent a marked enhancement of echo contrast was visible in the tumour tissue in all patients. Mean PI and PG were significantly higher in tumour tissue than in healthy brain parenchyma (11.8 v 5.1 dB and 0.69 v 0.16 dB/s; p < 0.001). TP did not differ significantly (37.1 v 50.2 s; p = 0.14). A tendency towards higher PI and PG as well as shorter TP was apparent in malignant gliomas. When comparing different tumour types, however, none of these variables reached significance, nor were there significant differences between malignant and benign tumours in general.

CONCLUSIONS

Second harmonic imaging not only allows identification of brain tumours, but may also help in distinguishing between different tumour types. It gives additional and alternative information about tumour perfusion. Further studies are needed to evaluate the clinical potential of this technique in investigating brain tumours-for example in follow up investigations of patients undergoing radiation or chemotherapy-especially in comparison with neuroradiological and neuropathological findings.

Understanding the limitations of ultrasonic backscatter measurements from microbubble populations

Despite over ten years of in vitro investigations of ultrasound contrast agents, the level of understanding of their behaviour in ultrasound fields is limited. Several problems associated with these investigations, particular to the nature of contrast agents, are discussed. Using a commercial scanner the RF normalized backscatter of two different contrast agents (Definity and Quantison) was measured at different suspension concentrations and acoustic pressures. Both contrast agents scattered ultrasound nonlinearly and the backscatter showed a dependence on acoustic pressure. In order to assess the average behaviour of the agents across the range of acoustic pressures and microbubble concentrations the experimental data were fitted to a theoretically acceptable model using nonlinear regression analysis. The analysis showed that both the backscatter and the attenuation of the Quantison suspensions displayed a higher order of dependence on acoustic pressure than the Definity suspensions. It was also discovered that Quantison microbubbles did not demonstrate uniform behaviour across the acoustic pressure range. At lower acoustic pressures the behaviour could not follow a model similar to that which predicted the behaviour at higher acoustic pressures, which was mainly due to the fact that free bubbles were released in a fashion dependent on acoustic pressure. The fact that two different populations of scatterers exist in the same suspensions makes the assessment of the behaviour of the particular agent impossible with the high concentrations that are commonly used. Very low concentration suspensions whereby single scattering events can be monitored should be more useful. In conclusion, the approach of using high microbubble concentrations in order to investigate the properties of ultrasonic contrast agents is limited in that the results of such studies cannot be used to understand the behaviour of single microbubbles.

An in vitro system for the study of ultrasound contrast agents using a commercial imaging system

An in vitro system for the investigation of the behaviour of contrast microbubbles in an ultrasound field, that provides a full diagnostic range of settings, is yet to be presented in the literature. The evaluation of a good compromise of such a system is presented in this paper. It is based on (a) an HD13000 ATL scanner (Bothell, WA, USA) externally controlled by a PC and (b) on the use of well-defined reference materials. The suspensions of the reference ultrasonic scattering material are placed in an anechoic tank. The pulse length ranges from 2 to 10 cycles, the acoustic pressure from 0.08 to 1.8 MPa, the transmit frequency from 1 to 4.3 MHz, and the receive frequency from 1 to 8 MHz. The collection of 256 samples of RF data, at an offset distance from the transducer face, was performed at 20 MHz digitization rate, which corresponds to approximately 1 cm depth in water. Two particle suspensions are also presented for use as reference scatterers for contrast studies: (a) a suspension of Orgasol (ELF Atochem, Paris, France) particles (approximately 5 microm mean diameter) and (b) a suspension of Eccosphere (New Metals & Chemicals Ltd, Essex, UK) particles (approximately 50 microm mean diameter). A preliminary experiment with the contrast agent Definity (DuPont Pharmaceutical Co, Waltham, MA) showed that the above two materials are suitable for use as a reference for contrast backscatter.

Contrast agent stability: a continuous B-mode imaging approach

The stability of contrast agents in suspensions with various dissolved gas levels has not been reported in the literature. An in vitro investigation has been carried out that studied the combined effect of varying the acoustic pressure along with degassing the suspension environment. In this study, the contrast agents were introduced into suspensions with different oxygen concentration levels, and their relative performance was assessed in terms of decay rate of their backscatter echoes. The partial pressures of oxygen in those solutions ranged between 1.5 and 26 kPa. Two IV and one arterial contrast agents were used: Definity, Quantison, and Myomap. It was found that Quantison and Myomap released free bubbles at high acoustic pressure that also dissolved faster in degassed suspensions. The backscatter decay for Definity did not depend on the air content of the suspensions. The destruction of bubbles was dependent on acoustic pressure. Different backscatter performance was observed by different populations of bubbles of the last two agents. The physical quantity of "overall backscatter" (OB) was defined as the integral of the decay rate over time of the backscatter of the contrast suspensions, and improved significantly the understanding of the behaviour of the agents. A quantitative analysis of the backscatter properties of contrast agents using a continuous imaging approach was difficult to achieve. This is due to the fact that the backscatter in the field of view is representative of a bubble population affected by the ultrasound (US) field, but this bubble population is not representative of the contrast suspension in the whole tank. Single frame insonation is suggested to avoid the effects of decay due to the ultrasonic field, and to measure a tank-representative backscatter. The definition of OB was useful, however, in understanding the behaviour of the agents.