Imaging Microbubbles in Children: A Light Foot on the Gas

Ultrasound Contrast Imaging: Fundamentals and Emerging Technology

“…Indeed, across the broad spectrum of all clinical contrast imaging applications, it is recommended to start at the manufacturers default contrast MI. If perfusion is still not well visualized after exhausting other image-enhancing strategies (e.g., receiver gain), then the MI should be increased by the smallest increment allowed on the given clinical system [18], with a maximum recommended MI between 0.2-0.3 [34][35][36]. However, specific techniques have been developed (e.g., disruption-replenishment [37,38]) whereby short duration, large MI pulses (e.g., high MI flash under the FDA limit of MI = 1.9) are employed to purposefully disrupt microbubbles in the focal volume, followed by a rapid switch back to low MI imaging pulses.…”

“…Microbubbles are approved in over 70 countries, predominately for cardiac applications, whereby their strong echo signal in the heart chambers improves left ventricular opacification (LVO). Recently, Lumason ™ was approved for liver imaging and in various pediatric applications [18]. Aside from the clinical uses listed here, microbubbles are currently in use worldwide in many off label clinical imaging applications, including assessment of microvascular perfusion (e.g., myocardial [19], angiogenesis imaging [20]), imaging of the carotid to assess vascular stenosis [21] and plaque stability [22], lesion and flow characteristics in the abdominal region [23,24], breast lesion detection [25], evaluation of inflammatory bowel disease [26], and assessment of ovaries [27], prostate [28] and thyroid [29].…”