CONTRAST AIDED ECHOCARDIOGRAM

Janny Garcia

Annie Nunez

Manuela Roman

Patricia Santana

PHYSICS

Basic Principle:

Doppler Effect- the effect of motion of sound in relation to the frequency of the sound by the observer.

V=(∆f c)/(2fcosθ)

Harmonic imaging- contrast enhanced ultrasound imaging

The reflection from the microbubbles at the second harmonic has the frequency 2(f + f), whereas that from the heart wall is at thefrequency (f + f). -the second harmonic difference 2∆f

CONTRAST AGENTSMicrobubbles:•Miniature gas bubbles of less than 50 micron diameter. •High degree of echogenicity.

•Enhance backscatter of the ultrasound waves producing a unique sonogram with increased contrast.

•Enhance grey scale images and flow mediated Doppler signals.

•Differ in shell make up, gas core makeup and whether or not they are target.

•First generation: Air filled microbubbles. Ex: Albunex

•Second Generation: Low solubility fluorocarbon gas.Ex: Optison, Levovist

• Third generation: Polymer shell and low solubility gas.Ex: Definity

DIFFERENT USES OF CONTRAST AIDED ULTRASOUND

Area Modality General Information ImageNephrolo

gyTTE Measures kidney enhancement and renal

flow (6)

Neurology

Transcranial Doppler (6) (-detailed information about the flow velocity in brain arteries and veins.)- Transpulmonary contrast agents (6)

- Diagnosis of cerebrovascular disease.(6)-Intracranial stenosis and occlusions-Assess collateral flow patterns-Identify arteriovenous malformations-Cerebral emboli-Mechanical compression of the vertebral arteries-Cerebral vasospasm in patients with subarachnoid hemorrhage. (17)

Vascular Medicine

-Carotid artery ultrasound-Renal artery ultrasound-Aorta and peripheral artery ultrasound-Venous ultrasound of both the upper and lower extremities-Intra-operative duplex ultrasonography (19)

-Diagnosis of deep venous thrombosis (DVT) (6)

Pre-natal 3-D and 4-D Ultrasound Fetal anomalies involving the face, limbs, thorax, spine and the central nervous system (15)

(15)

Type Procedure Parameters Measured Specific Diseases

Image

Transthoracic echocardiogra

m (TTE)

-most common- move the transducer to different locations on your chest or abdominal wall.(8)-noninvasive

- cause of abnormal heart sounds, enlarged heart, unexplained chest pains, shortness of breath, or irregular heartbeats- thickness and movement of the heart wall-assess functioning of artificial heart (8)

-cardiomyopathy-heart failure-blood clots-tumors (8)

Stress echocardiogra

m

- echocardiogram performed before and after heart is stressed (exercise or medicine that increases heart rate like dobutamine) (1)

Assess blood flow to heart (1)

coronary artery disease (CAD) (1)

Doppler echocardiogra

m

-like a regular echocardiogram

Assess blood flow (direction and speed) through the heart chambers, heart valves, and blood vessels

-cardiac valvular insufficiency -stenosis- large number of other abnormal flows.

Transesophageal

echocardiogram (TEE)

probe is passed down the esophagus (provides clearer image) (3)

- Assess the overall function of your heart’s valves and chambers- effectiveness of valve surgery- Evaluate abnormalities of the left atrium (3)

-valve disease --myocardial disease-pericardial disease -infective endocarditis -cardiac masses -congenital heart disease (3)

3-D Echocardiogra

phy

-ultrasound probe with an array of transducers and an appropriate processing system (12)Continuity equartion of structure is derived by dividing by the time-velocity integral of continuous waveDoppler profile.(13)

-detailed anatomical assessment of cardiac pathology (12)

-valvular defects-cardiomyopathies (12)-fetal tumors (14)

COMPARISON

Enhancement of image quality- Able to image small vessels and deep tissues/organs- Harmonic ultrasonic frequencies and mechanical indices

Strong signal production Manage ultrasonic frequencies Statistics

-Before contrast enhanced ultrasound(CEU) 86.7% of the echocardiograms had 2+ myocardial segments that could not be visualized. -After CEU, the average of myocardial segments visualized increased to 98.8% -CEU diagnostics helped avoid further indicative procedures(i.e. nuclear imaging) as seen in 32.8% of patients

Effective Cost

FUTURE OUTLOOK

Based on these research investigations we believe there will be extensive growth in regards to these certain areas: 3D Real Time Imaging Coronary Artery flow detection Flow Reserve measurements Endothelial integrity Intracavitary Pressure measurements Targeted delivery of drugs, ligands, and

genes

Any Questions?