Acoustically stimulated transient power scattering explains enhanced detection of the very low velocities in myocardial capillaries by power Doppler imaging: An in vitro study

Background: Although enhanced detection of myocardial perfusion signals by power Doppler imaging during contrast echocardiography has been noted, flow velocities in the coronary microvasculature should generally be below the threshold for Doppler motion detection. It has been suggested that in this situation nonlinear scattering related to acoustically stimulated microsphere oscillation or destruction may be responsible for the detected Doppler shift. Methods and Results: This study examined the behavior of MRX 115 (ImaRx Pharmaceuticals) microbubbles during harmonic and nonharmonic power Doppler imaging at varying power outputs (mechanical indexes 0.3, 0.5, 0.7, and 0.9) in a perfusion tube model under zero-now conditions. Boluses of MRX 115 0.5-mL, suspension were introduced into the model, and flow was halted during each imaging period. Once power Doppler imaging was implemented, a signal was detected as unique sparkling color pixels corresponding to individual bubble destruction events, even in the absence of contrast movement. This phenomenon continued until all contrast bubbles disappeared from the region subjected to power Doppler imaging, usually within 35 to 40 seconds. Off-line videointensity measurements showed that initial power Doppler signal intensity and maximum signal decay rates increased parallel to increasing power output and were substantially greater for nonharmonic than for harmonic imaging modes. Conclusion: This relationship between signal intensity and decay rate and acoustic power output suggests that transient scattering related to bubble destruction is responsible for generation of the power Doppler signal in the absence of now. This would explain the enhanced detection of the very low velocity flows in the myocardial capillaries by power Doppler contrast imaging.