Optimization of Microbubble Concentration and Acoustic Pressure for Left Ventricular High Frame Rate EchoPIV in Patients
Jason Voorneveld (Erasmus MC)
Lana B.H. Keijzer (Erasmus MC)
Mihai Strachinaru (Erasmus MC)
Daniel J. Bowen (Erasmus MC)
Ferit O. Mutluer (Erasmus MC)
Antonius F.W. Van der Steen (Erasmus MC, TU Delft - ImPhys/Medical Imaging)
Folkert Ten Cate (Erasmus MC)
Nico De Jong (TU Delft - ImPhys/Medical Imaging, Erasmus MC)
Hendrik J. Vos (TU Delft - ImPhys/Medical Imaging, Erasmus MC)
Annemien E. Van den Bosch (Erasmus MC)
Johan G. Bosch (Erasmus MC)
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Abstract
High-frame-rate (HFR) echo-particle image velocimetry (echoPIV) is a promising tool for measuring intracardiac blood flow dynamics. In this study, we investigate the optimal ultrasound contrast agent (UCA: SonoVue) infusion rate and acoustic output to use for HFR echoPIV (PRF = 4900 Hz) in the left ventricle (LV) of patients. Three infusion rates (0.3, 0.6, and 1.2 ml/min) and five acoustic output amplitudes (by varying transmit voltage: 5, 10, 15, 20, and 30 V - corresponding to mechanical indices of 0.01, 0.02, 0.03, 0.04, and 0.06 at 60-mm depth) were tested in 20 patients admitted for symptoms of heart failure. We assess the accuracy of HFR echoPIV against pulsed-wave Doppler acquisitions obtained for mitral inflow and aortic outflow. In terms of image quality, the 1.2-ml/min infusion rate provided the highest contrast-to-background ratio (CBR) (3-dB improvement over 0.3 ml/min). The highest acoustic output tested resulted in the lowest CBR. Increased acoustic output also resulted in increased microbubble disruption. For the echoPIV results, the 1.2-ml/min infusion rate provided the best vector quality and accuracy; mid-range acoustic outputs (corresponding to 15-20-V transmit voltages) provided the best agreement with the pulsed-wave Doppler. Overall, the highest infusion rate (1.2 ml/min) and mid-range acoustic output amplitudes provided the best image quality and echoPIV results.
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