title: Myocardial contrast echocardiography yields best accuracy using quantitative analysis of digital data from pulse inversion technique: comparison with second harmonic imaging and harmonic power Doppler during simultaneous dipyridamole stress SPECT studies.
abstract: OBJECTIVE
  This prospective study assesses the (1) feasibility of quantifying ultrasound myocardial perfusion studies based on the densitometric analysis of digital data and the (2) comparison of pulse inversion, second harmonic and harmonic power Doppler modalities with SPECT.
  
  
  RESULTS
  Twenty-three patients with suspected ischaemic heart disease had i.v. injections of Tc-Sestamibi and Optison during a dipyridamole stress test for echocardiography in pulse inversion, second harmonic and harmonic power Doppler mode. Analysis was (a) visual by scoring and (b) quantitative by densitometry of digital data for background subtracted myocardial opacification (a.u.) and normalized contrast effect (%). In the nine control patients, myocardial opacification at stress was greater (P< or =0.002) than in the pathologic group (5. +/- 3.3 vs 2.6 +/- 2.5 a.u. in pulse inversion, 5.4 +/- 2.1 vs 2.4 +/- 1.8 in second harmonic and 7.1 +/- 3.7 vs 4.9 +/- 3.7 a.u. in harmonic power Doppler). In the pathologic group, normalized contrast effect decreased significantly during stress (23.7 +/- 18.8 to 11.3 +/- 10.8%, P<0.003) only in pulse inversion. Kappa values for patient based diagnostic agreement with SPECT were 0.75 by pulse inversion, 0.62 by second harmonic and 0.52 by harmonic power Doppler for quantitative analysis, and 0.51, 0.37 and 0.35 respectively, for visual assessment.
  
  
  CONCLUSIONS
  Myocardial contrast echocardiography should be analysed using densitometry of digital data. The new technique pulse inversion demonstrates best agreement with SPECT data.
authors.affiliation: Department of Cardiology, Karolinska Hospital, Stockholm, Sweden. helene.vonbibra@ks.se
authors.forename: H
authors.initials: H
authors.lastname: von Bibra
authors.forename: D
authors.initials: D
authors.lastname: Bone
authors.forename: U
authors.initials: U
authors.lastname: Niklasson
authors.forename: L
authors.initials: L
authors.lastname: Eurenius
authors.forename: A
authors.initials: A
authors.lastname: Hansen
mesh_terms: D000418:Albumins; D003287:Contrast Media; D004176:Dipyridamole; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005466:Fluorocarbons; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014665:Vasodilator Agents
chemical_list: D000418:Albumins; D003287:Contrast Media; C099458:FS 069; D005466:Fluorocarbons; D014665:Vasodilator Agents; D004176:Dipyridamole