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Real-time perfusion imaging with low mechanical index pulse inversion Doppler imaging

^a Section of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA

View larger version (77K): [in a new window]   Figure 1 An example of an inducible anteroseptal contrast defect on PID imaging after intravenous Optison (apical three-chamber size). Note that at peak myocardial contrast (PMC) enhancement, there was no contrast defect. At 5 s after PMC, a defect was first observed (arrows). ED = end-diastole; ES = end-systole.

View larger version (73K): [in a new window]   Figure 2 An example of an inducible lateral wall perfusion defect (arrows; bottom panel) in the apical four-chamber view from a patient with significant left circumflex coronary artery (LCx) stenosis at angiography. The rest images from end-diastole to end-systole obtained with pulse inversion Doppler (PID) imaging are shown on the top panel. ED = end-diastole; ES = end-systole.

View larger version (75K): [in a new window]   Figure 3 An example of an inducible inferior myocardial contrast defect (arrows) on pulse inversion Doppler (PID) imaging in the apical two-chamber view after intravenous Optison administration in a patient with >50% diameter stenosis in the right coronary artery (RCA). Wall motion was considered normal in this patient both at rest and during stress.

View larger version (102K): [in a new window]   Figure 4 An example of the early appearance of an apical perfusion defect (arrows) in the apical four-chamber view after intravenous (IV) Optison administration during low dose dobutamine echocardiography. Rest contrast enhancement is shown in the right top panel, low dose dobutamine images in the left bottom panel and peak images in the right bottom panel. Both wall motion and contrast enhancement were abnormal in the apex at peak dobutamine stress (right bottom panel). This patient had significant left anterior descending coronary artery (LAD) stenoses on quantitative angiography (QA). The left upper panel is before ultrasound contrast under baseline conditions.