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in clinical investigations. Traditional the ultrasound image, improved tissue only, contrast only, or
Unique Live Dual display allows for simulta- Cadence CPS technology display selection
neous real-time viewing of CPS contrast of tissue-only image, contrast agent-only
image and derived B-mode image. perfusion image, or both together.
Phase Modulation Pulse 1 Phase Modulation Pulse 2
Compression Compression
Rarefaction Rarefaction
Figure 1: In the simple case of a pulse with a leading edge Figure 2: In the simple case of an inverted pulse (a leading
that expands the contrast agent bubble, a typical response edge that compresses the contrast agent bubble), a typical
may look like this. response may look like this.
A new technology is now available agent, the agent response is unique describing the interaction of con-
on the Sequoia platform that recog- and can be efficiently separated trast agent bubbles with ultrasound,
nizes and processes the unique from the tissue signals. The precise consider a pressure pulse and the
nonlinear fundamental and higher control of pulse amplitude and positive, compressional section of
order harmonic signals that are phase allows the detection of the pulse. This particular pulse sec-
generated by ultrasound contrast strong nonlinear fundamental tion compresses a bubble. When the
agents. Recent introductions of energy exclusively from the contrast bubble is compressed, a fixed
novel ultrasound contrast agents agent. This unique response is amount of sound is scattered and
that perform well at low MI include termed nonlinear, as it arises as reflected back to the transducer.
SonoVue, Definity, Optison, and a result of the bubbles nonlinear
Imagent. By means of a proprietary expansion and contraction with the Next, consider a second pressure
pulse that is twice as large as the
new pulse sequence technology ultrasound pulse. This response is
first with twice the amplitude.
ideally designed for contrast agents, also termed fundamental, as the
During the compressional section of
the agent-to-tissue specificity of bubbles strongest returned
this pulse, the bubble is compressed
contrast imaging is significantly response is at the same frequency
more than during the same section
increased thereby providing improved as the transmitted pulse.
of the smaller, first pulse. However,
performance even at low MI power
Phase Modulation changing a bubble expands much more easily
levels. By taking advantage of the
phase: A bubbles nonlinear expan- than it contracts; it has a nonlinear
extreme flexibility of the Sequoia
sion and contraction is sensitive response. Therefore, the section of
system, Cadence contrast pulse
to the initial phase as shown above the second pulse does not necessar-
sequencing technology (CPS) achieves
(Figures 1 and 2). In these exam- ily return half as much energy; i.e.
this new level of performance by
ples, the received pulses on the far the volume and scattering proper-
simultaneously processing received
right from two excitation pulses ties did not just simply drop by a
signals from multiple transmitted
of opposite phase help identify the factor of two. If the result were sim-
pulses of varying phase modulation
bubble from tissue. The recorded ply a factor of two in the scattered
and varying amplitude modulation.
signals are not simply inverted energy, this energy would be
It is now understood that by varying copies of each other, unlike that of termed linear. In this example
the phase and amplitude of multiple tissue. Amplitude Modulation when the energy scattered is not a
pulse interactions with a contrast changing amplitude: In further factor of two different, it is termed
Cadence Contrast Pulse Sequencing - CPS
Inter Pulse Amplitude Modulation and Phase Modulation
Composite Tissue Contrast Contrast
linear response nonlinear fundamental response nonlinear harmonic response
nonlinear. With Cadence CPS tech- Although Cadence CPS technology Next, a full-amplitude, negative
nology, we transmit a fundamental encompasses the design of many polarity, 180 degree, pulse is trans-
frequency and then detect a different pulse sequences for differ- mitted. The processed received sig-
returned fundamental frequency ent imaging characteristics, we nal includes similar significant com-
(the nonlinear fundamental) as well present one example of a Cadence ponents as the first received signal
as higher order harmonics from the CPS technology implementation (linear fundamental tissue, nonlin-
wobbling bubbles. (Figure 3), breaking down the ear fundamental contrast agent,
components of this multipulse and nonlinear harmonic contrast
Cadence CPS technology combines technology. agent components). The linear
multiple received pulses to extract tissue response and the nonlinear
the strong nonlinear signals. A half-amplitude, positive 0 degree fundamental response, again, carry
Conventional filtering methods like pulse is transmitted. The processed the same polarity of the transmitted
those used with phase inversion received signal includes: pulse. However, due to the bubbles
technologies are insufficient for nonlinear behavior, the nonlinear
- linear fundamental tissue,
detecting nonlinear fundamental fundamental contrast response
- nonlinear fundamental contrast
energy. Spectral filters that separate from this pulse exhibits a higher
agent, and - nonlinear harmonic
signals in the frequency domain are amplitude than the nonlinear fun-
contrast agent components.
not effective for separating linearly damental contrast response from
scattered fundamental tissue signals As the transmit power is very low, the first half-amplitude pulse. In
from nonlinearly generated funda- the nonlinear tissue harmonic com- addition, the nonlinear harmonic
mental bubble signals, as both sig- ponent of the received signal is very response carries its own polarity.
nal types are in the same fundamen- low and can be suppressed with
tal frequency band. Instead, separa- processing inherent in the Sequoia Another half amplitude, positive
tion is achieved by proprietary com- systems Coherent Imageformer. 0 degree pulse is transmitted. The
binations of multiple pulses with The linear tissue response and the processed received signal includes
Cadence CPS technology. Proper nonlinear fundamental response similar significant components as
amplitude and phase combinations carry the same polarity as the the first two received signals. The
support effective tissue signal rejec- transmitted pulse. The nonlinear linear tissue response and the non-
tion and bubble signal extraction harmonic response carries its linear fundamental response carry
all within the same fundamental own polarity. the same polarity as the transmitted
frequency band. pulse. The amplitude of the non-
linear fundamental contrast response The nonlinear fundamental compo- Cadence CPS technology is an
is similar to the first received pulse. nent of the contrast agent signal attractive technology for higher
The nonlinear harmonic response is very attractive for a number of frequency imaging, where acquir-
carries its own polarity. reasons: ing useful harmonic frequencies
Transmit Tissue Response Agent Response Transmit Tissue Response Agent Response
Xmt 2
High MI - Destruction
High MI - Destruction
Figure 4 Figure 5
Understanding Cadence A second Sequoia platform tech- separates the tissue image from
Agent Detection Imaging nology for contrast is Cadence the contrast agent image. You can
Technology agent detection imaging technolo- perform a scan and then from the
High MI imaging that provides gy, (ADI). This method is ideal for same dataset, view the tissue (as if
tissue only, contrast only, or investigations where higher trans- without contrast agent), only the
both together mit powers may be used and some contrast agent, or both together.
agent depletion is acceptable. In effect, you can view the baseline
Higher transmit levels deliver more scan at the same time as the
energy to the bubbles and force contrast scans.
more dramatic changes. High MI
imaging may also be referred to as Although there are other emission
emitted by the contrast bubbles only Cadence ADI and Cadence CPS
higher energy insonation, bubbles both together, all from the same
signal received from the patients the receive pulses together, with
examine the tissue only image, subtracted (Figure 5). Even if some
this image must be obtained prior contrast agent signal remains during
only image is needed after the ference still exists between the first