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Extra-Low Acoustic Power Harmonic Images of the Liver With Perflutren

Novel Imaging for Real-Time Observation of Liver Perfusion

Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan (H.M., S.M., H.S.); Toshiba Medical Engineering Laboratory, Tochigi, Japan (Y.M.); and Pharmaceutical Laboratories, Institute for Drug Discovery Research, Yamanouchi Pharmaceutical Co, Ltd, Ibaraki, Japan (H.Y., K.M.).

Address correspondence and reprint requests to Hitoshi Maruyama, MD, Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan. E-mail: maru-cib{at}umin.ac.jp

Objective. The features of images below the extra-low mechanical index level were studied to elucidate a suitable mechanical index level for observing real-time and continuous harmonic images of rabbit livers with VX-2 tumors with the use of perflutren. Methods. Eight New Zealand White rabbits, 2 with healthy livers and 6 with VX-2 tumors, were examined by harmonic imaging (1.85 and 3.7 MHz) at a frame rate of 17 Hz under various mechanical index levels. Results. Real-time enhanced images of the liver were observed continuously in all rabbits. Vascular images were more clearly visualized at the low mechanical index level (mechanical index, 0.18) than at any other level. However, predominant enhanced images of the whole liver were observed only at the extra-low mechanical index level (mechanical index, 0.06). In VX-2 tumors, tumor vessels were shown more clearly at a low acoustic power level than at an extra-low level. The histologically proved area of viable tumor was enhanced as a stain in the tumor nodule at an extra-low mechanical index level. Conclusions. Harmonic imaging under extra-low mechanical index levels with perflutren could provide real-time and continuous enhanced images of the liver, which would contribute to improvement of the diagnostic ability of contrast-enhanced sonography in liver diseases.

Key Words: contrast agent • harmonic imaging • liver • mechanical index • sonography

Abbreviations: MI, mechanical index

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