Pulse inversion imaging of liver blood flow - Improved method for characterizing focal masses with microbubble contrast

RATIONALE AND OBJECTIVES. TO create a microbubble contrast image of vessels that lie below the resolution of an ultrasound system, a technique is required that detects preferentially the agent echo, rejecting that from tissue. Harmonic imaging exploits the nonlinear behavior of microbubbles hut forces a compromise between image sensitivity and axial resolution, The authors describe and evaluate a new method that overcomes this compromise and improves contrast imaging performance: pulse inversion imaging. METHODS. Sequences of pulses of alternate phase are transmitted into tissue and their echoes summed. A prototype scanner equipped with pulse inversion was used to image phantoms and 16 patients with focal liver masses. RESULTS. Pulse inversion images show contrast sensitivity and resolution superior to that of harmonic images. Vessels can be imaged at an incident power sufficiently low to avoid destroying the agent, allowing unique visualization of tumor vasculature, Distinct patterns were seen in hemangiomas, metastases, and hepatocellular carcinomas. CONCLUSIONS. Pulse inversion imaging is an improved bubble-specific imaging method that extends the potential of contrast ultrasonography.