Detecting myocardial perfusion deficit with contrast-enhanced high frame rate ultrasound

Imaging the myocardial perfusion after a heart attack has a high prognostic value, because it can guide the clinicians for better treatment before, during, or after percutaneous coronary intervention (PCI). Contrast-enhanced ultrasound is a promising imaging modality because it can be performed quickly on bedside within or outside the Cathlab. However, the image quality may generally not be good enough for accurate assessment of the myocardial perfusion. We have developed a technique that uses higher-order singular value decomposition of high frame rate echocardiographic data, in combination with contrast-specific pulsing schemes, to detect flow and perfusion. To assess the sensitivity of our technique to detect the local interruption of myocardial perfusion, we performed in vivo measurements on a porcine model. The left anterior descending coronary artery was occluded by using a balloon catheter which mainly interrupted the flow into the apex of the heart. Data were acquired with an ultrasound research scanner and phased array, and processed offline. The results showed that we can localize the blood flow inside the myocardium and detect the interrupt when the vessel is occluded, which shows the first proof of concept.