title: Image enhancement by noncontrast harmonic echocardiography. Part II. Quantitative assessment with use of contrast-to-speckle ratio.
abstract: OBJECTIVE
  To ascertain whether "harmonic imaging"--use of ultrasound signals with the frequency twice that of the transmitted signal for ultrasound image generation--can improve image contrast while reducing noise.
  
  
  METHODS
  Technically difficult echocardiograms (nonvisualization of 2 or more endocardial segments in a 16-segment model) from 25 patients were analyzed. Corresponding fundamental and harmonic images of the left ventricle in the apical four-chamber, two-chamber, and long-axis views were divided into basal, mid, and apical regions. The difference in image quality between fundamental and harmonic scans was assessed by using the muscle-to-cavity contrast-to-speckle ratio (CSRmc).
  
  
  RESULTS
  The mean CSRmc values of pooled data revealed significant image enhancement by harmonic scanning (CSRmc increased from 0.84 to 1.06; P < 0.0001). Regression analysis showed that harmonic imaging improved the CSRmc values in 68% of all scans. Regional analysis indicated the most enhancement in basal regions (CSRmc increased from 0.96 to 1.34; P < 0.0001), followed by the mid (CSRmc increased from 0.84 to 1.04; P < 0.0001) and apical (CSRmc increased from 0.68 to 0.74; P = 0.0138) left ventricular regions.
  
  
  CONCLUSIONS
  Noncontrast harmonic imaging significantly enhances suboptimal echocardiographic images, particularly in the regions distant from the transducer.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA.
authors.forename: M
authors.initials: M
authors.lastname: Belohlavek
authors.forename: K
authors.initials: K
authors.lastname: Tanabe
authors.forename: S L
authors.initials: SL
authors.lastname: Mulvagh
authors.forename: D A
authors.initials: DA
authors.lastname: Foley
authors.forename: J F
authors.initials: JF
authors.lastname: Greenleaf
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
mesh_terms: D000328:Adult; D015986:Confounding Factors, Epidemiologic; D004452:Echocardiography / Q000379:methods*; D004699:Endocardium / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male