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Integrated backscatter and digital acquisition during myocardial contrast echocardiography: is there an advantage over conventional echocardiography for intracoronary injections?

This study was designed to answer the question of whether, despite their theoretic superiority, integrated backscatter imaging (IBS) and digital data acquisition (DA) offer any advantage over conventional echocardiography (CE) during quantitative myocardial contrast echocardiography. In vitro experiments were performed (1) to determine the microbubble concentration versus videointensity relationships for CE and IBS and (2) to define the relationship between flow through and microbubble transit rates for CE and IBS. These data were stored on videotape. In vivo experiments were performed whereby microbubbles were injected into the left anterior descending artery at different flow rates in 14 dogs and IBS and CE data were stored both in digital format and on videotape. Although the level of compression did not affect the microbubble concentration versus videointensity plots during IBS compared with CE, in practical terms the mean transit rate, peak intensity, and area under the curve were not affected by the level of compression for both forms of imaging as long as the postprocessing used for CE imaging was linear and the microbubble dose was small. In addition, although DA resulted in higher peak intensity and area under the curve compared with storage on videotape because of its broader dynamic range, the correlation between these measurements was excellent with both forms of image storage. We conclude that, although differences exist between CE and IBS and between Da and analog acquisition, these differences do not significantly affect the derivation of parameters from time-intensity plots during myocardial contrast echocardiography when contrast material is injected into a coronary artery.

Animals↗

PubMed2005

Stable polymeric microballoons as multifunctional device for biomedical uses: synthesis and characterization.

Gas filled hollow microparticles, i.e., microbubbles and microballoons, are soft matter devices used in a number of diverse applications ranging from protein separation and purification in food science to drilling technology and ultrasound imaging. Aqueous dispersions of these mesoscopic systems are characterized by the stabilization of the air/water interface by a thin shell of phospholipid bilayer or multilayers or by a denatured and cross-linked proteic matrix. We present a study of a type of microballoons based on modified poly(vinyl alcohol), PVA, a synthetic biocompatible polymer, with new structural features. A cross-linking reaction carried out at the air/water interface provides polymeric air-filled microbubbles with average dimensions depending on the reaction temperature. Characterization of diameters and shell thicknesses for microbubbles obtained at different temperatures has been carried out. Conversion to solvent-filled hollow microcapsules is possible by soaking microbubbles in dimethyl sulfoxide. Microcapsules permeability to fluorescent labeled dextran molecular weight standards was correlated to the mesh size of the polymer network of the shell. Microbubbles were covalently grafted under very mild conditions with beta-cyclodextrin and poly-l-lysine with a view to assay the capability of the device for delivery of hydrophobic drugs or DNA. PVA based microballoons show a remarkable shelf life of several months, their external surface can be decorated with many biologically relevant molecules. These features, together with a tested biocompatibility, make them attractive candidates for use as multifunctional device for diagnosis and therapeutic purposes, i.e., as ultrasound reflectors in ecographic investigation and as drug platforms for in situ sonoporation.

Air↗

PubMed1995

Dimethylformamide as an enhancer of cavitation-induced cell lysis in vitro.

Polar solvents, including dimethylformamide (DMF), have been investigated as anticancer drugs, but their potential usefulness is constrained by hepatotoxic side effects. The ability to enhance drug cytotoxicity with ultrasound would be valuable in creating locally intense chemotherapy while minimizing effects peripheral to the treatment site. The effects of continuous wave ultrasound (US) (985 kHz; 0.5-2.5 W/cm2) were evaluated on cultured HL-60 human promyelocytic leukemia cells alone and with a noncytotoxic DMF dose (0.11 M). The cells were insonified in a configuration that created no cell lysis without the introduction of albumin-stabilized microbubbles into the exposure chamber. When microbubbles were introduced, US with bubbles induced cell lysis, and the presence of DMF significantly increased the lysis induced by ultrasound with bubbles. The necessary presence of microbubbles for the DMF-US synergism to occur suggests that a likely mechanism is acoustic cavitation, initiated by the presence of microbubbles as nuclei. Detection of subharmonics confirmed the presence of cavitation, and cell lysis was well correlated with the subharmonic amplitude. The results show that albumin-stabilized microbubbles, similar to those currently used as US contrast agents, may provide a significant source of nuclei and improve prospects for cancer therapy using acoustic cavitation. The evidence presented supports the hypothesis that cell damage is due to a sonochemical rather than to a sonomechanical process.

Cell Membrane↗

PubMed1991

Effect of aminophylline on transpulmonary passage of venous air emboli in pigs.

Aminophylline has been shown to dramatically reduce the filtering capacity of the lung in dogs during venous air embolism. Similarities have been pointed out between the cardiovascular and respiratory systems of the pig and of humans. We therefore wanted to find out whether aminophylline also modifies the transpulmonary spillover of microbubbles to the arterial circulation of the pig. Twenty-eight pigs were anesthetized with pentobarbital sodium and mechanically ventilated. Aminophylline was injected intravenously into 10 of the pigs before the introduction of air bubbles into the right ventricle, while the other 18 pigs served as controls. A transesophageal echocardiographic probe was used to detect eventual air bubbles in the left atrium or in the aorta. Pigs received either air infusion, at rates varying from 0.05 to 0.20 ml.kg-1.min-1, or calibrated microbubbles, 5-300 microns diam. We found that aminophylline-treated pigs did not show any change in spillover incidence compared with controls. Furthermore, in both groups the spillover during continuous air infusion seemed to be a preterminal event, because the pigs had very low arterial pressure when arterial bubbles were observed. Finally, there was an increase in mean pulmonary arterial pressure from 18 +/- 3.4 to 26 +/- 2.2 (SD) mmHg (n = 4, P less than 0.01) in aminophylline-treated pigs after a bolus injection of microbubbles (less than or equal to 50 microns, total volume less than 0.5 ml). Our results suggest that aminophylline does not modify the transpulmonary passage of microbubbles in this porcine model. In addition, it would seem that the pulmonary circulation of the pig is sensitive to very small volumes of air, when injected as microbubbles.

Aminophylline↗

PubMed2005

RPE damage thresholds and mechanisms for laser exposure in the microsecond-to-millisecond time regimen.

PURPOSE: The retinal pigment epithelium (RPE) cells with their strongly absorbant melanosomes form the highest light-absorbing layer of the retina. It is well known that laser-induced retinal damage is caused by thermal denaturation at pulse durations longer than milliseconds and by microbubble formation around the melanosomes at pulses shorter than microseconds. The purpose of this work was to determine the pulse width when both effects merge. Therefore, the RPE damage threshold and mechanism of the damage at single laser pulses of 5-micros to 3-ms duration were investigated. METHODS: An argon laser beam (lambda 514 nm) was externally switched by an acousto-optic modulator to achieve pulses with constant power in the time range of 5 micros up to 3 ms. The pulses were applied to freshly prepared porcine RPE samples serving as a model system. After laser exposure RPE cell damage was proved by the cell-viability stain calceinAM. Microbubble formation was detected by acoustic techniques and by reflectometry. RESULTS: At a pulse duration of 5 micros, RPE cell damage was always associated with microbubble formation. At pulses of 50 micros, mostly thermal denaturation, but also microbubble formation, was detected. At the longer laser pulses (500 micros, 3 ms), RPE cell damage occurred without any microbubble appearance. CONCLUSIONS: At threshold irradiance, the transition time from thermal denaturation to thermomechanical damage of RPE cells is slightly below the laser pulse duration of 50 micros.

Animals↗

PubMed2001

Vibro-acoustography: quantification of flow with highly-localized low-frequency acoustic force.

The intersection of two ultrasound beams with slightly different frequencies results in generation of a localized radiation force and stimulates emission of audio signals from targeted objects. Vibro-acoustography uses this phenomenon to probe elastic properties of objects. Vibro-acoustography of contrast microbubbles in degassed water produced quantitative flow measurements from analysis of their acoustic emission. We used a dual-beam transducer generating bursts of 40-kHz vibrations. The vibrations resulted from interference of 3.48-MHz and 3.52-MHz confocal beams intersecting at the center of a thin plastic conduit. We tested flows of 13,48, 85, and 120 mL/min of contrast microbubbles at concentrations from 1.2 x 10(5) to 6 x 10(9) bubbles/mL. The amplitude of the acoustic emission was linear with microbubble concentrations up to a value of 3.6 x 10(5) bubbles/mL. A replenishment method for microbubble contrast and flow rate analysis was used with radiation force bursts deployed at 0.05, 0.1, 0.2, (.5, 1, and 2-second pulsing intervals. The relation between the pulsing intervals and the peak amplitude was fitted by an exponential curve and a rate constant calculated for each tested flow rate. The rate constant values were linearly correlated with the tested flows. The vibro-acoustography method provides objective, quantitative, and highly-localized assessment of flow using contrast microbubbles.

Acoustics↗

PubMed2006

Soft trapping and manipulation of cells using a disposable nanoliter biochamber.

Low-power continuous-wave laser radiation is used to form a very stable microbubble at the end of a specially etched and metalized optical fiber probe. We demonstrate that the microbubble, which is firmly attached to the fiber probe, can be used to benignly trap and manipulate living swine sperm cells as well as human embryonic kidney cells. The lifetime of the microbubble has been prolonged and the gaseous environment inside the bubble controlled using micropipette gas injection. The controlled fusion of two microbubbles is demonstrated as a means of transferring microparticles from one bubble to another. These experiments lay the foundation for the use of the microbubble as a mobile, nanoliter-volume disposable biochamber for cellular studies.

Animals↗

PubMed1998

Assisted venous drainage, venous air, and gaseous microemboli transmission into the arterial line: an in-vitro study.

The objective of this study was to examine the interaction of cardiopulmonary bypass venous air with assisted venous drainage, focusing on its production of gaseous microemboli in the arterial line. An in-vitro recirculating cardiopulmonary bypass circuit containing fresh whole bovine blood was monitored with a pulsed-doppler microbubble detector. Air of specific amounts was injected into the venous line and gaseous microemboli counts were obtained distal to the arterial filter. Data was recorded for unassisted drainage, vacuum-assisted drainage, and centrifugal pump-assisted drainage. Centrifugal pump-assisted drainage produced over 300 microbubbles in one minute distal to the arterial filter when venous air was introduced into the circuit. Of these, 220 were greater than 80 microns in size. Vacuum-assisted drainage produced no microbubbles when the same amount of venous air was introduced into the circuit. However, vacuum-assisted drainage did produce some microbubbles in the arterial line when a stopcock was left open on the venous line for 30 seconds. Unassisted drainage produced no microbubbles at all levels of venous air entrainment. Air becomes entrained in the venous line from a variety of sources. In a typical gravity-drained situation, the air remains whole and is dissipated in the venous reservoir by buoyancy and filtration. In an assisted-drainage situation, the air is subjected to additional forces. The air is subjected to a greater degree of negative pressure and, with centrifugal pump assisted drainage, is subjected to kinetic energy imparted by the cones or vanes of the pump. The kinetic energy from the centrifugal pump appears to break the air into small bubbles which become suspended in the blood, passing through the reservoir, oxygenator, and arterial filter. In a clinical setting, these bubbles would be passed into a patient's arterial system.

Animals↗

PubMed1986

Quantitation of echo-contrast effects.

With the recent development of sonicated microbubble echocardiographic contrast agents, it is now reasonable to attempt to quantitate actual tissue perfusion. However, this requires an understanding of the quantitative relationship between microbubble concentrations and the reflected ultrasound signal. This paper describes (1) the basic acoustic properties of sonicated microbubbles, and (2) experimental verification of this relationship, showing that the ultrasound signal actually begins to decrease at a critical concentration that may be predicted based upon bubble size. These microbubbles have acoustic properties that are essentially those of a random collection of Rayleighian scatters. Signal strength is governed primarily by the compressibility of gas, as opposed to fluid. In addition, bubble diameter is an important factor in determining signal strength (sixth power dependence). And, because the bubbles are randomly arranged, the reflected signal is not as great as might be expected, when compared to the signal reflected by a single bubble. A simple in vitro test of the acoustic analysis confirmed the critical limit for bubble concentration, the measurement of which led to a prediction for sonicated microbubble size that is within a factor of two of the published values. This acoustic analysis and confirmation, along with ongoing in vivo experimentation, promises to make possible quantitative regional perfusion measurement employing sonicated contrast agents.

Contrast Media↗

PubMed1980

DNA replication in Physarum polycephalum. Analysis of replicating nuclear DNA using the electron microscope.

DNA has been isolated from Physarum polycephalum nuclei obtained from macroplasmodia at different stages in the mitotic cycle, and examined using the electron microscope. Putative replicating structures were identified, the majority of which contained clusters of 2--37 'microbubbles', each microbubble corresponding to a segment of DNA 100--5000 nucleotides long. The microbubble-containing structures are unstable in the formamide hyperphase used to prepare specimens for electron microscopy, possibly due to dissociation of newly replicated nascent DNA fragments from the parental DNA template during manipulation. The microbubble clusters present in early S-phase DNA extent over segments averaging 16400 nucleotide residues, and are separated by non-replicated regions of DNA varying in length from 10000 to 50000 nucleotides. It is suggested that each microbubble cluster may represent a 'replicon', and that many 'replicons' in Physarum DNA may contain several sites for the initiation of DNA synthesis that are active during S-phase.

Cell Nucleus↗

PubMed1996

Intracardiac air clearing in valvular surgery guided by transesophageal echocardiography.

BACKGROUND AND AIMS OF THE STUDY: Air embolism during open heart surgery seems to be a common occurrence and may be responsible for neuropsychological deficit or myocardial damage. MATERIAL AND METHODS: Forty-two consecutive patients undergoing valvular surgery were studied using the long axis view of the heart by two dimensional transesophageal echocardiography (TEE). The patients were randomized into two groups of 21 each. In group 1, the routine air evacuation method was used. In group 2, the same air evacuation method was used and controlled with a Doppler ultrasonic probe adjusted around the root of the aorta. At the end of air evacuation, intracardiac microbubbles and retained air were analyzed with TEE and when air was founded, its location was communicated to the surgeons who tried to remove it by shaking the heart and tilting the operating table for 15 minutes. The patients were assessed for detection of cardiac or neurological postoperative complications. RESULTS: The incidences of microbubbles and retained air were 57% and 43% in group 1, and 62% and 38% in group 2 respectively (ns). The mean grade of microbubbles was lower in group 2: 1.4 +/- 0.8 vs. 2.2 +/- 0.9, p < 0.05. TEE allowed to significantly decrease (p < 0.05) retained air and mean grade of microbubbles to 14% and 1.3 +/- 0.8 in group 1, and to 10% and 0.8 +/- 0.8 in group 2, without statistical difference between the two groups. Despite the help of TEE, manual attempts to eradicate retained air were unsuccessful in five patients (three in group 1, two in group 2). CONCLUSIONS: The use of aortic ultrasonic probe allowed to reduce the amount of microbubbles. TEE was a useful tool not only for the detection of retained air but also for locating it, and guiding the procedure to eliminate it.

Adolescent↗

PubMed2003

Myocardial contrast echocardiography for assessment of myocardial perfusion at rest in a patient with left main coronary artery stenosis.

The present case will focus on the potential of hypoperfusion detection with myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI). PDHI is normally performed in a triggered mode. Microbubbles were destroyed by the ultrasound energy in the myocardium, and myocardium has to be refilled with microbubbles within the time interval between the ultrasound pulses to obtain repetitive information about perfusion. Using the contrast agent Levovist, however, real-time PDHI also results in myocardial opacification presumably due to perfusion signals of the arteriolar microbubble passage. A 45-year-old woman with typical stress-induced angina was admitted to our department for cardiac catheterization. Prior to the angiography a conventional echocardiogram showed normal left ventricular function. Tissue Doppler, however, demonstrated postsystolic longitudinal shortening of the septal, anterior, and lateral wall regions. Myocardial contrast echocardiography with triggered PDHI showed complete opacification of the myocardium at rest. Using real-time PDHI with Levovist, the septum could not be opacified. The consecutive angiography documented a severe unprotected main coronary artery stenosis. After angioplasty and stent implantation, MCE measurements were repeated. Repetitive intravenous bolus injections of Optison during triggered PDHI showed no differences to the investigation prior to the angioplasty. Using real-time PDHI with Levovist, however, there was a marked difference in comparison to the pre-interventional analysis. A complete opacification of the apical septum was observed. The present case suggests that different MCE techniques can analyze different compartments of the myocardial vasculature in clinical practice. This methodological comparison between triggered and real-time PDHI shows obviously differences in the DI signal detection due to the different microbubble behavior. Clinicians should be aware of the potentials of MCE to improve noninvasive diagnostic procedures in patients with ischemic heart disease.

Albumins↗

PubMed2004

Image enhancement by acoustic conditioning of ultrasound contrast agents.

A novel contrast imaging technique has been developed for use with microbubble contrast agents. It employs two acoustic fields: there is an excitation field for conditioning microbubbles and an imaging field for detecting microbubbles. The maximum increases (due to microbubble conditioning) in scattered first and second harmonic signals were 14.5 and 16 dB, respectively. This technique is unique for effectively enhancing the blood-to-tissue image contrast.

Albumins↗

PubMed2005

High-speed optical observations of contrast agent destruction.

Ultrasound contrast agents are now available since a few years and used for diagnostic purposes. Improved diagnostic decisions have been made possible with new imaging methods that are mainly based on the nonlinear properties of gas microbubbles. Since it is well known that contrast agents are destroyed by ultrasound when the acoustic pressure exceeds a threshold, extremely low acoustic pressures were applied to achieve enhanced contrast image quality. However, destruction of contrast microbubbles is not necessarily undesirable, since it is beneficial in, for example, destruction/reperfusion imaging and recently in drug delivery. We investigate in this experimental study the destruction dynamics of a contrast agent consisting of nitrogen bubbles encapsulated in a double polymer/albumin wall shell. This is accomplished using an ultrafast camera Brandaris that operates at a frame rate of 25 MHz and records 128 frames. The measurements were performed with an ultrasound sine burst of 10 cycles at 1.7 MHz. Different acoustic pressures were applied and various microsphere sizes were examined. The results show three different zones depending on the applied pressure and bubble size: these are nondestruction zone, transient zone and destruction zone. The nondestruction zone is reached for either very small microspheres or low mechanical indices (MI) (<0.3). In the destruction zone lie either large microspheres (5 microm or higher) even when irradiated at low MIs or small microspheres (<5 microm) when the MI is above 0.6. The optical observations revealed that the destruction of the microspheres is characterized by shell rupture and gas release. The release of the gas gives rise to new free microbubble that lasts for a few milliseconds and then disappears due to dissolution. In the transient zone, the microspheres are mainly compressed in the first few cycles but no expansion is induced. After intense compressions, the shell fissures and gas escapes in the last cycles of the burst or during a second burst depending on the initial size and MI. These optical recordings are important to investigate contrast bubble destruction and can help in amplifying or minimizing this process. Indeed, bubble disruption remains the basis of most current sensitive methods for detecting perfusion with contrast agents and is an essential component of perfusion quantification with microbubbles, in addition to drug delivery applications and pressure measurements.

Algorithms↗

PubMed2003

Validation of ultrasound contrast destruction imaging for flow quantification.

Our purpose was to validate in vitro a kinetic flow model based on microbubble signal decay curve. Using a 3.5 MHz transducer and phase-inversion (1.8 MHz central transmit frequency), a renal dialysis cartridge oriented vertically was imaged in the transverse plane as 1:1000 dilution of AF0150 was infused at 50, 100, 200, 300 and 400 mL/min. Ten gray-scale images were acquired at each infusion rate using 2.5, 5 and 10 frames/s at 100%, 40%, 15% or 1% of maximum transmit power. Video-intensity measured on each 10 images was fit to a kinetic model using Sigma Plot that yielded microbubble concentration, velocity and destruction per frame. These were correlated with the experimental conditions. At 100% power, video-intensity on the first frame (microbubble concentration at equilibrium) was similar for all flow and frame rates. The model fit the experimental data for all flows at 10 frames/s and for flows lower than 400 and 100 mL/min at 5 frames/s and 2.5 frames/s, respectively. The calculated flow was similar to the experimental flow rates, regardless of technique (r(2) = 0.98). Microbubble fraction destroyed per frame was similar for all flow and frame rates and increased linearly with transmit power (r(2) > 0.98). These results suggest that using appropriate power and frame rate for a given flow rate, estimates of fractional blood volume, flow and destruction fraction can be calculated from the decay curve using 10 frames that can be acquired in 1 to 4 s.

Contrast Media↗

PubMed2006

Ultrasonic contrast agent shell rupture detected by inertial cavitation and rebound signals.

Determining the rupture pressure threshold of ultrasound contrast agent microbubbles has significant applications for contrast imaging, development of therapeutic agents, and evaluation of potential bioeffects. Using a passive cavitation detector, this work evaluates rupture based on acoustic emissions from single, encapsulated, gas-filled microbubbles. Sinusoidal ultrasound pulses were transmitted into weak solutions of Optison at different center frequencies (0.9, 2.8, and 4.6 MHz), pulse durations (three, five, and seven cycles of the center frequencies), and peak rarefactional pressures (0.07 to 5.39 MPa). Pulse repetition frequency was 10 Hz. Signals detected with a 13-MHz, center-frequency transducer revealed postexcitation acoustic emissions (between 1 and 5 micros after excitation) with broadband spectral content. The observed acoustic emissions were consistent with the acoustic signature that would be anticipated from inertial collapse followed by "rebounds" when a microbubble ruptures and thus generates daughter/free bubbles that grow and collapse. The peak rarefactional pressure threshold for detection of these emissions increased with frequency (e.g., 0.53, 0.87, and 0.99 MPa for 0.9, 2.8, and 4.6 MHz, respectively; five-cycle pulse duration) and decreased with pulse duration. The emissions identified in this work were separated from the excitation in time and spectral content, and provide a novel determination of microbubble shell rupture.

Albumins↗

PubMed2005

Assessment of endogenous and therapeutic arteriogenesis by contrast ultrasound molecular imaging of integrin expression.

BACKGROUND: We hypothesized that molecular imaging with contrast-enhanced ultrasound (CEU) and microbubbles targeted to endothelial integrins could be used to noninvasively assess early angiogenic responses to ischemia and growth factor therapy. METHODS AND RESULTS: Hindlimb ischemia was produced in 48 rats by ligation of an iliac artery. Half of the animals received intramuscular sustained-release fibroblast growth factor-2 (FGF-2). Immediately after ligation and at subsequent intervals from 4 to 28 days, blood flow and oxygen tension in the proximal adductor muscles were measured by CEU perfusion imaging and phosphor quenching, respectively. Targeted CEU imaging of alpha(v)- and alpha5beta1-integrin expression was performed with microbubbles bearing the disintegrin echistatin. Iliac artery ligation produced a 65% to 70% reduction in blood flow and oxygen tension. In untreated ischemic muscle, muscle flow and oxygen tension partially recovered by days 14 to 28. In these animals, signal from integrin-targeted microbubbles was intense and peaked before flow increase (days 4 to 7). In comparison to untreated animals, FGF-2-treated muscle had a greater rate and extent of blood flow recovery and greater signal intensity from integrin-targeted microbubbles, which peaked before maximal recovery of flow. On immunohistology, arteriolar but not capillary density increased in the ischemic limb after ligation, the rate and degree of which were greater in FGF-2-treated rats. Immunofluorescence demonstrated intense staining for alpha(v) in arterioles, the temporal course of which correlated with targeted imaging. CONCLUSIONS: Targeted CEU can be used to assess endogenous and therapeutic arteriogenesis before recovery of tissue perfusion. These results suggest that molecular imaging of integrin expression may be useful for evaluating proangiogenic therapies.

Animals↗

PubMed2005

Hemodynamic and morphologic changes of peripheral hepatic vasculature in cirrhotic liver disease: a preliminary study using contrast-enhanced coded phase inversion harmonic ultrasonography.

AIM: To provide the useful information for the diagnosis of liver cirrhosis by observing the morphology of peripheral hepatic vessels and the hemodynamics of microbubble arrival time in these vessels. METHODS: Twenty-one subjects including 5 normal volunteers and 16 patients (liver cirrhosis, n=10; chronic hepatitis, n=6) were studied by contrast-enhanced coded phase inversion harmonic sonography (GE LOGIQ 9 series) using a 6-8 MHz convex-arrayed wide-band transducer. The images of peripheral hepatic artery, portal and hepatic vein were observed in real-time for about 2 min after intravenous injection of Levovist. The time when microbubbles appeared in the peripheral vessels (microbubble arrival time) was also recorded. The morphologic changes of peripheral hepatic vasculature were classified as marked, slight, and no changes based on the regularity in caliber, course, ramification, and the delineation of vessels compared to normal subjects. RESULTS: The microbubble arrival time at peripheral artery, portal, and hepatic vein was shorter in cirrhotic patients than in chronic hepatitis patients and normal subjects. The marked, slight and no morphologic changes of peripheral hepatic vasculature found in 5 (5/6, 83.3%), 1 (1/6, 16.7%), and 0 (0/6, 0%) liver cirrhosis patients, respectively, and in 1 (1/10, 10%), 6 (6/10, 60%), and 3 (3/10, 30%) chronic hepatitis patients, respectively. There was a significant difference between the two groups (P< 0.001). CONCLUSION: Evaluation of the hemodynamics and morphology of peripheral hepatic vasculature by contrast-enhanced coded pulse inversion harmonic sonography can provide useful information for the diagnosis of liver cirrhosis.

Adolescent↗