Table 3 Examples of images obtained by utilising default settings on Philips EPIQ or GE Vivid systems
From: Contrast echocardiography: a practical guideline from the British Society of Echocardiography
System Philips EPIQ CVX system with X5-1 3D probe Contrast mode ‘Contrast LVO’ (CGen) pre-set defaults to harmonic mode and an intermediate MI > 0.2 Focal point Set at mitral valve level | In this example the default MI is intermediate at 0.30, and the imaging mode is Harmonic. Opacification is not homogenous and there is apical swirling |
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System Philips EPIQ CVX system with X5-1 3D probe Contrast mode ‘Contrast LVO’ (CPen) manually adjusting CGen to CPen changes imaging mode from harmonic to fundamental and MI reduces simultaneously to a low MI < 0.20 Focal point Set at mitral valve level | This example was achieved by changing the imaging mode from harmonic to fundamental, which automatically reduces the MI to low (0.19). This results in less bubble destruction and homogenous LV opacification without apical swirling. At this MI there is obvious contrast in the myocardium, but both epicardial and endocardial borders remain discernible |
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System Philips EPIQ CVX system with X5-1 3D probe Contrast mode ‘Contrast Low MI’ (CPen) pre-set defaults to fundamental imaging; low MI < 0.20 with additional tissue cancellation techniques operating in the background Focal point Set at mitral valve level | The ‘low-MI’ pre-set has several algorithms which optimises imaging. Despite superficially similar settings to the previous example, here the signal-to-noise ratio is improved such that microbubbles can be seen in the myocardium at a higher intensity. This makes both endocardial and epicardial borders clearer, no bubble destruction is seen in the nearfield, and opacification is homogeneous However, the presence of myocardial apical defect can be overcome moving the focal point towards the apex as explained below |
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System GE Vivid E95 system with a M5Sc 2D probe Contrast mode ‘LV Contrast’ pre-set (harmonic imaging; intermediate MI at 0.21) Focal point Set at mitral valve level | In this example, apical swirling may result, this mode of imaging relies on an intermediate MI leading to some bubble destruction in the nearfield |
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System GE Vivid E95 system with a M5Sc 2D probe Contrast mode ‘LVO Stress’ pre-set (harmonic imaging; intermediate MI at 0.21) Focal point Set at mitral valve level | The images vary slightly from the LV Contrast images since the LVO Stress mode has been designed for acquisition at higher heart rates and continuous capture |
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System GE Vivid E95 system with a M5Sc 2D probe Contrast mode ‘Contrast Low MI’ pre-set (harmonic imaging; low MI at 0.10) Focal point Set at mitral valve level | Image resolution is not optimal, myocardial opacification is likely to be background noise and not true perfusion. However, GE is currently refining this mode of imaging |
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