Assessment of resting perfusion with myocardial contrast echocardiography: theoretical and practical considerations

The aim of this study was to perform a quantitative comparison between myocardial contrast echocardiography (MCE) and single-photon emission computed tomography (SPECT) in patients with prior myocardial infarction (MI). We also wanted to determine the optimal method for the intravenous administration of an ultrasound contrast agent in the clinical setting.

Seventeen patients with resting perfusion defects in a single vascular territory on SPECT were studied. MCE was performed with intermittent harmonic imaging during continuous infusions of a second-generation ultrasound contrast agent (Sonovue, Bracco Diagnostics) in all 17 patients and after bolus injection in 8 of them. During continuous infusions, the video intensity (VI) ratio between the abnormal and normal myocardium at a pulsing interval (PI) of 8 cardiac cycles correlated well with the activity ratio between these segments on SPECT (r = 0.73, P <.01). When information regarding microbubble velocity (MV) denoted as change in VI with increasing PIs was added, the correlation with SPECT activity ratio improved (P <.05) significantly (r = 0.87, P <.0001). Higher microbubble doses resulted in higher VI during continuous infusions with good myocardial opacification and no far-field attenuation until the highest dose was reached. With bolus injections, the VI ratio between the abnormal and normal myocardium at PI of 1 and 5 cardiac cycles showed a modest correlation (r = 0.46 and r = 0.48, respectively, P <.05) with activity ratios between these regions on SPECT. When a dose of microbubbles administered as a bolus produced adequate myocardial opacification, it invariably resulted in far-field attenuation.

In patients with prior MI, quantitative assessment of resting perfusion defects on MCE correlates well with regional activity on SPECT. Continuous infusions offer an advantage over bolus injections because they can provide an assessment of both relative VI and MV. Adjustment of the microbubble infusion rate produces adequate myocardial opacification without attenuation.