(PII) Pulse inversion imaging (also called phase inversion imaging) is a non-linear imaging method specifically made for enhanced detection of microbubble ultrasound contrast agents. In PII, two pulses are sent in rapid succession into the tissue; the second pulse is a mirror image of the first. The resulting echoes are added at reception. Linear scattering of the two pulses will give two echoes which are inverted copies of each other, and these echoes will therefore cancel out when added.
Linear scattering dominates in tissues. Echoes from linear scatterers such as tissue cancel, whereas those from gas microbubbles do not. Non-linear scattering of the two pulses will give two echoes which do not cancel out completely due to different bubble response to positive and negative pressures of equal magnitude. The harmonic components add, and the signal intensity difference between non-linear and linear scatterers is therefore increased. The resulting images show high sensitivity to bubbles at the resolution of a conventional image.
In harmonic imaging, the frequency range of the transmitted pulse and the received signal should not overlap, but this restriction is less in pulse inversion imaging since the transmit frequencies are not filtered out, but rather subtracted. Broader transmit and receive bandwidths are therefore allowed, giving shorter pulses and improved axial resolution, hence the alternative term wideband harmonic imaging. Many ultrasound machines offer some form of pulse inversion imaging.

See also Pulse Inversion Doppler, Narrow Bandwidth, Dead Zone, Ultrasound Phantom.

Bubble specific imaging methods rely usually on non-linear imaging modes. These contrast imaging techniques are designed to suppress the echo from tissue in relation to that from a microbubble contrast agent.
Stimulated acoustic emission (SAE) and phase / pulse inversion imaging mode (PIM) are bubble specific modes, which can image the tissue specific phase.
In SAE mode bubble rupture is seen as a transient bright signal in B-mode and as a characteristic mosaic-like effect in velocity 2D color Doppler.
PIM are Doppler modes and detect non-linear echoes from microbubbles. In pulse inversion imaging modes the transducer bandwidth extends, resulting in improved spatial resolution and more contrast.

See also Contrast Pulse Sequencing, Microbubble Scanner Modification, Narrow Bandwidth, Contrast Medium, Dead Zone.

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The earliest introduction of vascular ultrasound contrast agents (USCA) was by Gramiak and Shah in 1968, when they injected agitated saline into the ascending aorta and cardiac chambers during echocardiographic to opacify the left heart chamber. Strong echoes were produced within the heart, due to the acoustic mismatch between free air microbubbles in the saline and the surrounding blood.