Gray scale [also grayscale, grey scale = brit.] produces basically black and white images with series of shades of gray. Solid areas appear white and fluid areas appear black, varying from black at the weakest intensity to white at the strongest. Gray scale resolves artifacts as small as 1 mm. The display is made by transmitting bursts of energy and analyzing the returning signal. Gray scale pictures are limited to the gray scale tones; color pictures display more information because the color is added to the gray scale.
Most ultrasound contrast agents also improve gray scale visualization of the flowing blood to such a degree that the tissue echogenicity increases. Gray scale enhancement of flow in an organ promises to improve lesion detection, along with the ability to differentiate between normal and abnormal areas, using many of the criteria already routinely used in CT and MRI.

See also Compress, Densitometry, Triplex Exam and QB-Mode.

Harmonic B-mode imaging takes advantage of the non-linear oscillation of microbubbles. During harmonic imaging, the sound signal is transmitted at a frequency of around 1.5 to 2.0 MHz and received at twice this frequency. The microbubbles also reflect waves with wavelengths different from the transmitted one, the detectors can be set to receive only the latter ones and create only images of the contrast agent.
Using bandpass filters the transmitted frequency is separated from the received signal to get improved visualization of vessels containing ultrasound contrast agents (USCAs). The signal to noise ratio during the presence of microbubbles in tissue is four- to fivefold higher at the harmonic compared with the basic frequency.
Using harmonic B-mode imaging, harmonic frequencies produced by the ultrasound propagation through tissue have to be taken into account. The tissue reflection produces only a small amount harmonic energy compared to USCAs, but has to be removed by background subtraction for quantitative evaluation of myocardial perfusion.

See also Non-linear Propagation.

Harmonic imaging relies on detection of harmonics of the transmitted frequency produced by bubble oscillation. This method is widely available on ultrasound scanners and uses the same array transducers as conventional imaging. A major limitation of the use of ultrasound contrast agents is the problem that signals from the microbubbles are mixed with those from tissue. Echoes from solid tissue and red blood cells are suppressed by harmonic imaging.
In harmonic mode, the system transmits at one frequency, but is tuned to receive echoes preferentially at double that frequency, and the second harmonic echoes from the place of the bubble. Typically, the transmit frequency lies between 1.5 and 3 MHz and the receive frequency is selected by means of a bandpass filter whose center frequency lies between 3 and 6 MHz.
Color Doppler and real-time harmonic spectral Doppler modes have also been implemented and show a level of tissue motion suppression not available in conventional modes.

See also Harmonic B-Mode Imaging, and Harmonic Power Doppler.

(HPD) Harmonic power Doppler is currently one of the most sensitive techniques for detecting ultrasound contrast agents. HPD works by transmitting multiple pulses toward the object to be imaged and detecting the pulse-to-pulse changes in the received echo signals.
Second harmonic bandbass filtering is applied to the received signals to exploit the non-linear behavior of scattering from bubbles (clutter). Harmonic power Doppler operates best at high output levels because of increased contrast destruction, and pulse amplitudes close to the maximum allowed are used much of the time.
With a high mechanical index, non-linear propagation of the sound will cause significant harmonic components from tissue, and the contrast agent to tissue ratio will decrease.
Also called Harmonic Power Angio. See also Multiple Frame Trigger.

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.