title: Detection of coronary artery stenosis with power Doppler imaging.
abstract: BACKGROUND
  Power Doppler is a new imaging method for detecting microbubbles during myocardial contrast echocardiography (MCE) based on the registration of variance resulting from ultrasound-induced nonlinear bubble behavior. We tested the hypothesis that power Doppler imaging can be used to quantify coronary stenoses.
  
  
  RESULTS
  Three left anterior descending (LAD) coronary stenoses of varying severity were created in each of 9 open-chest dogs. MCE was performed by continuous intravenous infusion of a nitrogen-filled bilayer shell microbubble, PB127, during triggered power Doppler imaging at incremental pulsing intervals. MCE and radiolabeled microsphere measurements were made at baseline and during each stenosis, with and without adenosine stress. Videointensities in the LAD and left circumflex (LCx) beds were plotted against pulsing interval and fit to a previously described exponential function modeling microbubble destruction and replenishment, which was used to derive parameters of bubble velocity (beta) and peak plateau videointensity (A). Contrast defects matching the location of radiolabeled microsphere hypoperfusion were clearly seen, without need for image processing. The product of beta and A was linearly related to LAD/LCx flow (r=0.90, P<0.0001) and inversely related to stenosis gradient (r=-0.70, P<0.0001). Endocardial/epicardial flow ratios were visualized and quantifiable.
  
  
  CONCLUSIONS
  As with B-mode harmonics, a model of microbubble destruction/replenishment can be applied to power Doppler data as a means to detect a broad range of stenoses. Image clarity and the lack of attenuation or requirement for background subtraction are additional advantages of this imaging approach. Power Doppler MCE imaging holds promise for the detection of coronary artery disease.
authors.affiliation: University of Pittsburgh School of Medicine, Cardiovascular Institute, 200 Lothrop St, S568 Scaife Hall, Pittsburgh, PA 15213, USA. villanuevafs@msx.upmc.ed
authors.forename: F S
authors.initials: FS
authors.lastname: Villanueva
authors.forename: E W
authors.initials: EW
authors.lastname: Gertz
authors.forename: M
authors.initials: M
authors.lastname: Csikari
authors.forename: G
authors.initials: G
authors.lastname: Pulido
authors.forename: D
authors.initials: D
authors.lastname: Fisher
authors.forename: J
authors.initials: J
authors.lastname: Sklenar
mesh_terms: D000818:Animals; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D004285:Dogs; D004452:Echocardiography; D018608:Ultrasonography, Doppler