Bubble destruction describes the microbubble shell rupture by ultrasound pulses. The bubble destruction increases with increasing peak negative pressure and decreasing frequency. The mechanical index is an indicator for the effectiveness of microbubble destruction. Contrast enhanced ultrasound relies on bubble rupture to detect bubbles in small vessels.

See also Negative Bolus.

(MI) The mechanical index is an estimate of the maximum amplitude of the pressure pulse in tissue. It is an indicator of the likelihood of mechanical bioeffects (streaming and cavitation). The mechanical index of the ultrasound beam is the amount of negative acoustic pressure within a ultrasonic field and is used to modulate the output signature of US contrast agents and to incite different microbubble responses.
The mechanical index is defined as the peak rarefactional pressure (negative pressure) divided by the square root of the ultrasound frequency.
The FDA ultrasound regulations allow a mechanical index of up to 1.9 to be used for all applications except ophthalmic (maximum 0.23). The used range varies from 0.05 to 1.9.
At low acoustic power, the acoustic response is considered as linear. At a low MI (less than 0.2), the microbubbles undergo oscillation with compression and rarefaction that are equal in amplitude and no special contrast enhanced signal is created. Microbubbles act as strong scattering objects due to the difference in impedance between air and liquid, and the acoustic response is optimized at the resonant frequency of a microbubble.
At higher acoustic power (MI between 0.2-0.5), nonlinear oscillation occurs preferentially with the bubbles undergoing rarefaction that is greater than compression. Ultrasound waves are created at harmonics of the delivered frequency. The harmonic response frequencies are different from that of the incident wave (fundamental frequency) with subharmonics (half of the fundamental frequency), harmonics (including the second harmonic response at twice the fundamental frequency), and ultra-harmonics obtained at 1.5 or 2.5 times the fundamental frequency. These contrast enhanced ultrasound signals are microbubble-specific.
At high acoustic power (MI greater than 0.5), microbubble destruction begins with emission of high intensity transient signals very rich in nonlinear components. Intermittent imaging becomes needed to allow the capillaries to be refilled with fresh microbubbles. Microbubble destruction occurs to some degree at all mechanical indices. A mechanical index from 0.8 to 1.9 creates high microbubble destruction. The output signal is unique to the contrast agent.

(CCI) A major limitation of the use of ultrasound contrast agents is the problem that signals from the microbubbles are mixed with those from tissue, so that the distribution of the microbubbles is not optimally displayed either in Doppler or gray scale.
Coherent contrast imaging is a high frame rate implementation of inverting the phase of alternate sound pulses and summing the resulting echoes. The symmetrical signals from linear reflectors are cancelled leaving those from non-linear scatterers, with the advantage that the cancellation is performed without the need to transmit two pulses per image line so that bubble destruction is minimized. Coherent contrast imaging yields best results in the vascular phase of phospholipid microbubbles (such as Definity and SonoVue).

See also Coherence.

Contrast agents improve the sensitivity of vascular Doppler ultrasound, for example in cerebrovascular sonography or examinations of deep abdominal vessels. They also enlarge the role of transcranial Doppler. Microbubbles can be used with various modes e.g., color and power Doppler imaging, as well as pulsed-wave Doppler to increase the signal intensity. However, the ultrasound system must be suitable for contrast enhanced technology.
Microbubbles usually stay within the vascular space; nevertheless, the contrast enhancement is limited to 2−6 minutes caused by physiologic clearance and bubble destruction.
Depended on the application, contrast agents can be administered with a different injection rate e.g., bolus injection, slow injection, or continuous infusion. Stable, homogeneous, and prolonged enhancement can be obtained with perfusion, lasting until the infusion is stopped.

See also Cerebrovascular Ultrasonography, Multiple Frame Trigger.

In contrast enhanced ultrasound, the focus is the point at which maximum bubble destruction occur.
The transmit focus is the region on the axis of an ultrasound beam where the width of the beam has a minimum value. All waves crossing the focus are in phase in relation to the transducer surface or to the electronic summing point of an electronically focused array.