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Technical Aspects of Contrast Echocardiography
In 2001, the American Society of Echocardiography (ASE) published a position paper that provided guidelines for sonographers performing contrast-enhanced echocardiographic studies. This chapter focuses on the sonographer’s role in four specific areas: (1) understanding of microbubble physics and ultrasound instrumentation, (2) recognition of indications for the use of contrast media, (3) need for establishment of intravenous (IV) access privileges, and (4) development of written policies for contrast agent infusion or injection. The purpose of this chapter is to discuss the technical aspects and provide tips for the use of contrast enhancement to optimize the visualization of endocardial borders and cardiac structures.
Indications
The 2008 ASE guidelines suggested that ultrasound-enhancing agents (UEAs) should be used when two or more left ventricular (LV) segments cannot be adequately visualized for the assessment of LV function, including ejection fraction and regional wall motion (RWM). , The use of UEAs for LV opacification improves the feasibility, accuracy, and reproducibility of echocardiography for the qualitative and quantitative assessment of LV structure and function at rest and during exercise or pharmacologic stress testing. Contrast enhancement facilitates the identification and assessment of intracardiac masses, such as tumors and thrombi; improves the visualization of the right ventricle and great vessels; and enhances Doppler signals used for evaluating valvular function. UEAs should be considered to document or exclude the following structural abnormalities: apical hypertrophy, noncompaction, thrombus, endomyocardial fibrosis, LV apical ballooning, LV aneurysm, LV pseudoaneurysm, and myocardial rupture. UEAs may also be considered to identify and characterize intracardiac masses and to differentiate cardiac structural variants.
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