Display for subtraction imaging techniques

[0002] Conventional ultrasound scanners create two-dimensional B-mode images of tissue in which the brightness of a pixel is based on the intensity of the echo return. In a so-called “color flow” mode, the flow of blood or movement of tissue can be imaged. Conventional ultrasound flow imaging methods typically use either the Doppler principle or a time-domain cross-correlation method to estimate the average flow velocity, which is then displayed in color overlaid on a B-mode image.

[0003] Measurement of blood flow in the heart and vessels using the Doppler effect is well known. The frequency shift of backscattered ultrasound waves may be used to measure the velocity of the back-scatterers from tissue or blood. The frequency of the backscattered signal increases when blood flows toward the transducer and decreases when blood flows away from the transducer, the amount of increase or decrease being proportional to the velocity of the blood flow. Thus this frequency shift may be used to estimate the average flow velocity, which is displayed using different colors to represent speed and direction of flow. The color flow velocity mode displays hundreds of adjacent sample volumes simultaneously, all color-coded to represent each sample volume's velocity.

[0004] The resulting flow image may be combined with a stationary tissue (i.e., B-mode) image acquired by detecting either the fundamental or (sub)harmonic signal components, either by summation or as an overlay in order to provide anatomical landmarks. An advantage of the overlay is that it may be done in color so that the flow regions stand out clearly. However, this method requires a more complex display. Furthermore, the flash artifacts resulting from surrounding tissue motion are severe. Injection of the background B-mode image by summation (either coherent or incoherent) results in more benign flash artifacts. In either case, however, additional firings beyond those used for flow imaging are required to acquire the imaging data representing stationary tissue.

[0005] An alternative method for imaging blood flow is B-flow. In B-flow, high spatial resolution is achieved by using broadband pulses, while high frame rate is achieved by using small packet sizes. High SNR/dynamic range is maintained by using coded excitation. Flow sensitivity in the range direction is highest and arises from pulse-to-pulse RF decorrelation, while flow sensitivity in the cross-range direction is due to pulse-to-pulse amplitude decorrelation as a group of reflectors (e.g. blood or contrast agents) flows across the beam profile.

[0006] The method includes transmitting a small packet of coded broadband pulses with a given pulse repetition interval to a transmit focal position. The packet size is made small (e.g., 2-4 firings) to achieve high frame rate, with the undesirable side effect of reduced SNR. SNR can be optionally recovered using coded excitation. A coded sequence of broadband pulses (centered at a fundamental frequency) is transmitted multiple times to a particular transmit focal position, each coded sequence constituting one firing. On receive, the receive pulses acquired for each firing are decoded and bandpass filtered, e.g., to isolate a spatially compressed pulse centered at the fundamental frequency. The backscattered signals from this sequence of firings are then filtered in slow time to remove echoes from stationary or slowly moving reflectors along the transmit path. The slow-time filtering is preferably performed by a high-pass FIR (finite impulse response) or IIR (infinite impulse response) wall filter, which increases the flow signal-to-clutter ratio. A flow image is formed by scanning the transmit focal position across the region of interest. Frame rate may be increased by simultaneously processing more than one receive vector from a single transmit vector with parallel receive hardware. The packet size, pulse repetition interval (PRI) and region of interest (ROI) may be optionally controlled by the user.

[0007] When imaging blood flow of very small blood vessels often down to the perfusion bed of the organ, the signals are of such low amplitude and the blood moving so slowly that conventional flow imaging techniques are not able to extract an adequate flow signal. In cases like this, contrast agents such as gas-filled microbubbles are optionally injected into the blood to serve as markers for imaging blood flow. As previously described above, a coded sequence of broadband pulses is transmitted multiple times to a particular transmit focal position. Fundamental and (sub/ultra) harmonic signals are generated from interaction between the transmitted ultrasound pulses and the propagation medium, especially the injected contrast agents. On receive, the receive signals are decoded and bandpass filtered to selectively isolate the fundamental or (sub/ultra) harmonic signals. These isolated selectively filtered signals are then high-pass filtered across firings using a conventional wall filter. As a result of this filtering, selectively filtered signals reflected from non-stationary tissue or flow regions along the transmit path are extracted, while received energy at the frequencies which would have contributed to undesirable stationary tissue signal is suppressed.

[0008] The imaging modes described above reduce the signal from normal surrounding tissue to allow the user to effectively image signals substantially lower in amplitude. In the case of Coded Harmonic Angio (CHA) and Coded Angio (CA) modes, both developed for contrast agent imaging, the signal is that from injected contrast agents in very small blood vessels often down to the perfusion bed of an organ. In the case of B-flow mode, the user is able to image blood flow using (unlike Doppler) the high frequency, wideband imaging pulses commonly used for B-mode imaging, with frame rates that are comparable to B-mode.

[0009] Unfortunately, the absence of the surrounding tissue background that enables good visualization of these low lying signals makes it very difficult for the user to do active imaging, since the visualization of the anatomical landmarks allowing the user to optimally position the probe is limited. For certain applications, such as the early detection of certain vascular diseases, the limited tissue background imaging associated with the blood flow imaging is not ideal. More specifically, if the resolution of the background imaging was clear, the background image would provide a reference image that can be used by a sonographer to establish a reference for the anatomy being scanned. Unfortunately, using the present non-Doppler based methods of blood flow imaging described above often results in little or no background tissue imaging. Therefore, it would be desirable to provide the user a background tissue image, without sacrificing the system frame rate or destroying the imaging resolution of the blood flow low amplitude signals.

[0010] The above discussed and other drawbacks and deficiencies are overcome or alleviated by a method for displaying flow and reference background ultrasound images. The method comprises: transmitting at least first and second broadband pulses to a common transmit focal position; receiving at least first and second ultrasound reflections associated with the at least first and second broadband pulses; forming a flow and/or contrast agent signal component based on the at least first and second ultrasound reflections; forming a B-mode background signal component based on independent processing of at least one of the at least first and second ultrasound reflections; and displaying an ultrasound image including a flow/contrast agent image component in a first image portion of a display and a B-mode reference image component based on at least one of the at least first and second ultrasound reflections, said B-mode reference image component displayed in a second image portion of said display.

[0011] In an alternative embodiment, an ultrasound medical diagnostic system for imaging stationary and moving reflectors for an area of interest in a patient is disclosed. The ultrasound diagnostic system includes a transmitter for transmitting a sequence of at least two pulses to a transmit focal position and a receiver for receiving at least two echo signals associated with the sequence of at least two pulses. The echo signals contain a fundamental frequency component. The system further includes a first display processor configured to receive and process the at least two echo signals and is configured having a filter for supplying a filtered signal containing flow/contrast agent image information for moving reflectors based on the at least two echo signals. Also included is a second display processor configured to receive and independently process at least one of the at least two echo signals containing B-mode information for stationary reflectors based on the at least two echo signals, the B-mode information for stationary reflectors including said fundamental frequency component. A display is included for displaying a flow/contrast agent image of moving reflectors based on the filtered signal and a B-mode reference image of stationary reflectors based on the at least one of at least two echo signals supplied by the second display processor.

[0012] The above discussed and other features and advantages of the present invention will be appreciated and understood by those skilled in the art from the following detailed description and drawings.

[0013] Referring to the exemplary drawings wherein like elements are numbered alike in the several Figures:

[0014] FIG. 1 is a block diagram of a conventional B-mode ultrasound imaging system switchable between a B-mode processor and a second colorflow processor for processing corresponding transmit firings;

[0015] FIG. 2 is a block diagram of an ultrasound imaging system in accordance with an exemplary embodiment of the disclosure;

[0016] FIG. 3 is a block diagram showing two independent processors/detectors of FIG. 2 in more detail to formulate a reference image and a flow image;

[0017] FIG. 4 is a block diagram showing independent processing of a one return signal from a multi-firing group used to generate a separate reference image signal to a display device in accordance with one preferred embodiment of the invention;

[0018] FIG. 5 is a block diagram showing independent processing of two return signals from a multi-firing group used to generate a separate reference image signal to a display device in accordance with one preferred embodiment of the invention;

[0019] FIG. 6 is a schematic diagram of a display device showing one video format for viewing a reference image and a flow image; and

[0020] FIG. 7 is a schematic diagram of the display device of FIG. 5 showing an alternative video format for viewing a reference image and a flow image.

[0021] A conventional ultrasonic imaging system is depicted in FIG. 1. The system comprises a transducer array 10 comprising a plurality of separately driven transducer elements 12, each of which produces a burst of ultrasonic energy when energized by a pulsed waveform produced by a transmitter 14. The ultrasonic energy reflected back to transducer array 10 from the object under study is converted to an electrical signal by each receiving transducer element 12 and applied separately to a receiver 16 through a set of transmit/receive (T/R) switches 18. The T/R switches 18 are typically diodes which protect the receive electronics from the high voltages generated by the transmit electronics. The transmit signal causes the diodes to shut off or limit the signal to the receiver. Transmitter 14 and receiver 16 are operated under control of a master controller 20 responsive to commands by a human operator. A complete scan is performed by acquiring a series of echoes in which transmitter 14 is gated ON momentarily to energize each transducer element 12, and the subsequent echo signals produced by each transducer element 12 are applied to receiver 16. A channel may begin reception while another channel is still transmitting. Receiver 16 combines the separate echo signals from each transducer element to produce a single echo signal which is used to produce a line in an image on a display monitor 22.

[0022] Under the direction of master controller 20, transmitter 14 drives transducer array 10 such that the ultrasonic energy is transmitted as a directed focused beam. To accomplish this, respective time delays are imparted to a plurality of pulsers 24 by a transmit beamformer 26. Master controller 20 determines the conditions under which the acoustic pulses will be transmitted. With this information, transmit beamformer 26 determines the timing and amplitudes of each of the transmit pulses to be generated by pulsers 24. The amplitudes of each transmit pulse are generated by an apodization generation circuit 36, which may be a high-voltage controller that sets the power supply voltage to each pulser. Pulsers 24 in turn send the transmit pulses to each of elements 12 of transducer array 10 via T/R switches 18, which protect time-gain control (TGC) amplifiers 28 from the high voltages which may exist at the transducer array. Weightings are generated within apodization generation circuit 36, which may comprise a set of digital-to-analog converters that take the weighting data from transmit beamformer 26 and apply it to pulsers 24. By appropriately adjusting the transmit focus time delays in a conventional manner and also adjusting the transmit apodization weightings, an ultrasonic beam can be directed and focused to form a transmit beam. The apodization weightings and the transmit focus delays may be set by the master controller 20 based on system programming and operator inputs.

[0023] The echo signals produced by each burst of ultrasonic energy are backscattered from objects located at successive ranges along each transmit beam. The backscattered echo signals are sensed separately by each transducer element 12 and a sample of the magnitude of the echo signal at a particular point in time represents the amount of reflection occurring at a specific range. Due to differences in the propagation paths between a reflecting point and each transducer element 12, the echo signals from a specific range will not be detected simultaneously by each transducer element 12 and their amplitudes will not be equal. Receiver 16 amplifies the separate echo signals via a respective TGC amplifier 28 in each receive channel. The amount of amplification provided by the TGC amplifiers is controlled through a control path (not shown) that is driven by a TGC circuit (not shown), the latter being set by the master controller and hand operation of potentiometers. The amplified echo signals are then fed to a receive beamformer 30. Each receiver channel of the receive beamformer is coupled to a respective one of transducer elements 12 by a respective TGC amplifier 28.

[0024] Under the direction of master controller 20, receive beamformer 30 tracks the direction of the transmitted beam. Receive beamformer 30 imparts the proper time delays and receives apodization weightings to each amplified echo signal and sums them to provide an echo signal which accurately indicates the total ultrasonic energy reflected from a point located at a particular range along one ultrasonic beam. The receive focus time delays are computed in real-time using specialized hardware or are read from a look-up table. The receive channels also have circuitry for filtering the received pulses. The time-delayed receive signals are then summed and supplied to either a signal processor or detector 33 in one path for conventional B-mode processing, or to another signal processor or detector 32 for colorflow and/or Doppler flow processing. Master controller 20 selects between detectors 32 and 33 via a switch 35 to convert the summed receive signals to data suitable for display dependent on the type of transmit firing being transmitted. For B-mode (gray scale) data, detector 33 extracts the envelope of the returning signal, usually applying some additional processing, such as edge enhancement and logarithmic compression. For colorflow, detector 32 typically applies a high pass filter to remove stationary tissue signal, and extracts a phase shift which is an indication of the velocity of the moving blood. A scan converter 34 receives the display data from detectors 32, 33 and converts the data into the desired image for display. In particular, scan converter 34 converts the acoustic image data from polar coordinate (R-⊖) sector format or Cartesian coordinate linear array to appropriately scaled Cartesian coordinate display pixel data at the video rate. These scan-converted acoustic data are then provided for display on display monitor 22, which images the time—varying amplitude of the signal envelope as a gray scale. A respective scan line is displayed for each transmit beam.

[0025] In the conventional system, the special flow and/or contrast imaging modes, such as B-flow, CHA, and CA, are typically processed using the B-mode detector 33, and detector 32 is either unused or continues to be used for Doppler processing.

[0026] FIG. 2 shows an ultrasound flow imaging system in accordance with an exemplary embodiment for use in medical diagnostics. In this system, each transducer element 12 in the transmit aperture is pulsed N times (where N is preferably 2 to 4) using a possibly coded waveform. The appropriate waveform to be transmitted is supplied by the transmit sequence memory 38 to each pulser for each firing. Pulsers 24 drive elements 12 of transducer array 10 such that the ultrasonic energy produced is directed or steered in a beam for each transmit firing. To accomplish this, transmit focus time delays 36 are imparted to the respective pulsed waveforms produced by the pulsers in response to transmit sequence 38. By appropriately adjusting the transmit focus time delays in a conventional manner, the ultrasonic beam can be focused at a desired transmit focal position.

[0027] For each transmit, the return echo signals from transducer elements 12 are fed to respective receive channels 40 of the receive beamformer. Under the direction of master controller 20 (FIG. 1), the receive beamformer tracks the direction of the transmitted beam. The receive beamformer imparts the proper receive focus time delays 42 to the received echo signal and sums them to provide an echo signal which accurately indicates the total ultrasonic energy reflected from a particular position along a transmit beam. The time-delayed receive signals are summed in a receive summer 44 for each of the N transmit firings focused at a particular transmit focal position.

[0028] Referring to FIGS. 2 and 3, the summed receive signals for successive transmit firings are received in detector 32 and are possibly decoded if a coded waveform has been transmitted, bandpass filtered, and provided to a wall filter, which filters across the N transmit firings and then supplies a filtered signal to a post processing unit 54. Post processing unit 54 forms the envelope of the firing-to-firing filtered signal, and performs optional compression and/or further post-processing.

[0029] Another signal processor or detector 133 selects at least one of the N transmit firings via a waveform selector 37, performs decoding if a coded waveform has been selected, and processes the same simultaneously with processing in detector 32 discussed above for providing a separate signal indicative of a stationary or slowly moving structure, e.g., background tissue. Waveform selector 37 is optionally controlled by master controller 20 by configuring master controller 20 to select at least one of the firings of the N transmit firings. After post-processing (including possible edge enhancement and logarithmic compression) and scan conversion of the two signals from detectors 32, 133, a scan line is displayed on display monitor 22 (FIG. 1). This procedure is repeated so that a respective scan line is displayed for each transmit focal position (in the case of one transmit focal position for each beam angle) or for each vector (in the case of multiple transmit focal positions for each beam angle).

[0030] In accordance with one exemplary embodiment of the invention still referring to FIGS. 2 and 3, detector 32, which processes the flow/contrast agent signal, includes a filter 46 further comprising an FIR filter 48 having an input coupled to the output of receive beam summer 44; and a vector summer 50 having an input coupled to FIR filter 48 and an output coupled to envelope detection and optional further post processing 54. The FIR filter effectively combines pulse compression, if coded excitation is being used, bandlimiting, and together with the vector summer, the wall filter. The FIR filter has M filter taps for receipt of a respective set of M filter coefficients for each transmit firing. The filter coefficients for the n-th transmit firing are a_nc⁰, a_nc₁, . . . , a_nc_M−1, where a_nis the scalar weighting for the n-th transmit firing, n=0, 1, . . . , N−1, and c₀, c₁ⁿ, . . . , c_M−1is a set filter coefficients which are selected so that FIR filter 48 passes a major fraction of the desired fundamental frequencies or desired (sub/ultra) harmonic frequencies in the receive signal. If a coded waveform has been transmitted, the c₀, c₁, . . . c_M−1coefficients also include the pulse compression decoding filter. The scalar weightings a₀, a₁, . . . , a_N−1form a “wall” filter in slow time which selectively passes signals from reflectors moving at a velocity greater than a predetermined threshold. The filter coefficients a_nc₀, a_nc₁, . . . , a_nc_M−1are supplied to the filter for each transmit firing by the master controller from a filter coefficient memory 52. For example, for the first transmit firing, the set of filter coefficients a₀c₀, a₀c₁, . . . , a₀c_M−1is supplied to the FIR filter; for the second transmit firing, the set of filter coefficients a₁c₀, a₁c₁, . . . , a₁c_M−1is supplied to the FIR filter; and so forth. The filter coefficients are programmable depending upon the diagnostic application. Different sets of filter coefficients can be stored in look-up tables inside the master controller memory and the desired set of coefficients can be selectable by the system operator. For applications where the number of transmit firings N=2, pairs of sets of filter coefficients are stored in memory, one set of filter coefficients of a selected pair being transferred to the FIR filter before the first transmit firing and the other set of filter coefficients of the selected pair being transferred to the FIR filter after the first transmit firing and before the second transmit firing. Similarly, for applications where the number of transmit firings N=3, two or three sets of filter coefficients are stored in memory for use in filtering the receive signals resulting from the first through third firings. A similar procedure is enacted for applications where the number of transmit firings N>3. The successive FIR filter output signals for the N transmit firings are accumulated in a vector summer 50. The output signal of the vector summer then undergoes conventional B-mode processing (envelop detection and logarithmic compression), followed by scan conversion and display.

[0031] Still referring to FIGS. 2 and 3, detector 133 includes an input to receive at least one transmit firing from waveform selector 37 for generating a B-mode reference using detector 133 as a second B-mode processor for simultaneous and independent processing of a subset of the transmit firings used to form a flow/contrast agent image signal in detector 32. The input of detector 133 receives at least one transmit firing from the multiple firing group processed in detector 32, and passes it through FIR filter 48, which applies pulse compression if a coded waveform has been transmitted and performs bandwidth limiting. It has P filter taps for receipt of a respective set of P filter coefficients for each transmit firing. The filter coefficients d₀, d₁, . . . , d_P−1, where d₀, d₁, . . . , d_M−1is a set of filter coefficients which are selected so that FIR filter 48 passes a major fraction of the desired fundamental frequencies or desired (sub/ultra) harmonic frequencies in the receive signal. If a coded waveform has been transmitted, the d₀, d₁, . . . d_P−1coefficients also include the pulse compression decoding filter. The filter coefficients d₀, d₁, . . . , d_P−1are supplied to the filter for each transmit firing by the master controller from a filter coefficient memory 52. The filter coefficients are again programmable depending upon the diagnostic application. Different sets of filter coefficients can be stored in look-up tables inside the master controller memory and the desired set of coefficients can be selectable by the system operator. In the case of transmitting uncoded wave forms, or coded waveforms that only require one firing for decoding, have been transmitted, only one firing is input to detector 133, and only one set of filter coefficients needs to be supplied by Filter Coefficient Memory 52. In the case that codes requiring multiple firings for decoding are used, such as Golay codes which require two firings to perform pulse compression, two waveforms are input to detector 133, and two sets of filter coefficients are used, one for each waveform. For applications where the number of transmit firings N=2, one set of filter coefficients of a selected pair is transferred to the FIR filter before the first transmit firing and the other set of filter coefficients of the selected pair being transferred to the FIR filter after the first transmit firing and before the second transmit firing. If the number of transmit firings input to detector 133 is more than 1 (as is the case for decoding Golay codes), successive FIR filter output signals for the multiple transmit firings are accumulated in a vector summer 50. The output signal of the vector summer then undergoes conventional B-mode processing (envelop detection and logarithmic compression), followed by scan conversion and display.

[0032] The time interval between each of the N transmits per focal position is user controllable to determine the “slow-time” filter cutoff frequency. A longer interval between each of the N transmits to a particular focal position results in a lower cutoff frequency with higher sensitivity to low velocity flow.

[0033] The flow/contrast agent image is optionally displayed by itself in one portion of display 22 for maximum image contrast, or may be overlayed with a B-mode background image. Superimposition of the flow image on a conventional B-mode image allows the diagnostician to observe the flow of blood relative to known anatomical landmarks during medical diagnosis.

[0034] In one preferred embodiment depicted in FIG. 4, a traditional B-mode reference image is derived from one firing 56 of a multi-firing group 58 in B-flow, Coded Angio (CA), or Coded Harmonic Angio (CHA) imaging. More specifically, if single transmit firing codes are being used in B-flow, CHA and CA imaging, only one firing 56 from the multi-firing group 58 is required to form a traditional B-mode image. The single firing 56 is independently processed by processor/detector 133 separate from processing the multi-firing group 58 by processor/detector 32. Detector 133 generates a reference image signal 60 indicative of tissue background to display 22 while detector 32 generates a flow image signal 62 indicative of fluid flow or contrast agents to display 22. Reference image signal is further processed to provide a first image portion on display 22 indicative of stationary background for providing a reference image 100 (See FIGS. 6 and 7). Flow/contrast agent image signal 62 is further processed to provide a second image portion on display 22 indicative of fluid flow/contrast agent dynamics for providing a flow/contrast agent image 102 in conjunction with a corresponding flow image signal.

[0035] In an alternate embodiment depicted in FIG. 5, two firings 66 and 68 (e.g., a pulse inverted pair) of the CHA multi-firing group 58, for example, are optionally used to form a harmonic reference image. Tissue imaging for the reference image can be improved by using harmonics (e.g., the 2^nd, 3^rdor higher harmonics) which are at a frequency higher than the fundamental frequency. For example, harmonic imaging at twice the fundamental frequency can increase image quality due to higher spatial resolution, and also due to the presence of fewer artifacts or interference in the second harmonic signal than the signal at the fundamental frequency. This is due to the fact that harmonic frequencies are created along the wave propagation path rather than at the transmission source. As before, the two firings 66 and 68 are independently processed by processor/detector 133 separate from processing the multi-firing group 58 by processor/detector 32. Detector 133 generates reference image signal 60 indicative of tissue background to display 22 while detector 32 generates flow/contrast agent image signal 62 indicative of fluid flow/contrast agent to display 22. Reference image signal 60 is further processed to provide a first image portion on display 22 indicative of stationary background for providing a reference image 100 (See FIGS. 6 and 7). Flow/contrast agent image signal 62 is further processed to provide a second image portion on display 22 indicative of fluid flow/contrast agent dynamics for providing an image 102 in conjunction with a corresponding flow/contrast agent image signal.

[0036] In yet another example using coded excitation, as many firings as are necessary in the decoding process are received in processor 133. For example, if Golay codes are being used in the B-flow firing sequence, two firings from the number being transmitted are necessary to properly decode the codes. Coded transmission can further increase the signal amplitude and SNR by transmitting a waveform at the amplitude of the regular transmission method but of a longer pulse duration. The instantaneous power in the coded transmission is the same as in the regular transmission. However, the coded transmission method transmits more energy by transmitting a longer ultrasound waveform, therefore penetration is typically greater for coded waveforms than for waveforms that are uncoded.

[0037] A pair of Golay-encoded base sequences are formed by convolving a base sequence with a Golay code pair after oversampling. A Golay code pair is a pair of binary (+1, −1) sequences with the property that the sum of the autocorrelations of the two sequences is a Kronecker delta function. An oversampled Golay sequence is the Golay sequence with zeroes between each +1 and −1, the number of zeroes being greater than or equal to the length of the base sequence minus one. Golay codes have no range sidelobes when decoded. For each firing, decoding is performed using the oversampled Golay sequence corresponding to the Golay-encoded base sequence employed during transmission. By transmitting two sequences of pulses that are polarity-encoded according to a Golay pair, correlation of each of the received beamsum signals with its corresponding oversampled Golay sequence and the summation of those correlations enables an increase in the SNR with virtually no degradation in image resolution or contrast. In practice, range sidelobes do occur due to code distortion, but tend to be below the noise floor and do not adversely affect image quality. Tissue motion that occurs between transmission of the two sequences of the Golay pair also causes code distortion, which increases the range sidelobes. By transmitting the second sequence as soon as the echoes from the first sequence are completely received, the time interval between the two transmits can be minimized. Minimization of the interval between transmits minimizes the motion-induced code distortion.

[0038] In each of the embodiments illustrated in FIGS. 4 and 5, the waveforms forming the reference image 100 is generated using a subset of those already being transmitted for the B-flow, CHA, or CA processing, thus not affecting the frame rate. The subsequent processing of these waveforms to provide the reference image is completely independent of the B-flow, CHA, or CA processing. In such case, the reference image quality is independently optimized. For example the receive frequency band can be adjusted to allow the reference image to be filtered (single firing) harmonic image rather a simple fundamental B-mode image.

[0039] In addition, since the reference image 100 is formed from a subset of the multiple firings 58 already being fired, the reference image 100 is simultaneously displayed with the subtraction mode images. This is in contrast with colorflow, where the firings for the color image and underlying B-mode are done separately leaving some temporal discrepancy between the two images. The temporal discrepancy is particularly obvious when the scanning frame rates are low.

[0040] Referring to FIGS. 6 and 7, multiple display formats can be employed to display the subtraction mode flow image 102 and the reference image 100. In one embodiment depicted in FIG. 6, a side-by-side multi-image format is shown with the B-flow/CHA/CA flow image 102 displayed on one side of monitor 22, while the reference image 100 is simultaneously displayed on the other side. In an alternate embodiment illustrated in FIG. 7, the reference image is optionally used as an overlay image to the B-flow/CHA/CA flow image 102. The overlay is preferably such that it is transparent allowing the user to visualize the B-flow/CHA/CA flow image 102 underlying the reference image 100. Alternatively, one of the images is optionally colorized while keeping the other image in shades of gray. In yet another embodiment, the B-mode reference image 100 is optionally overlaid in areas where a B-flow/CHA/CA signal is absent, using a thresholding or adaptive process to determine whether to display the reference image 100 or B-flow/CHA/CA flow image 102. Finally, the B-mode reference image can be used as the underlying image, with the B-flow/CHA/CA used as the overlay, with the same image combination means (transparency, colorizing, thresholding) as described above. The above described display modes preferably include switch 104 to allow a sonographer the option to quickly toggle the reference image 100 on and off for optimizing the visualization of the dynamics of fluid flow under study.

[0041] When using a single-transmit code, exemplar embodiments require at least two transmits of the code, with the resulting echoes being “slow-time” filtered by the wall filter. In contrast, using Golay codes, acquisition of two data points at different times requires four transmits, two for each Golay code of the Golay code pair. Therefore, use of two-transmit codes requires at least four coded transmits. During wall filtering, the same set of scalar weightings are applied to the echoes of both Golay codes of the Golay code pair. Additional uncoded transmits can be included in the packet to acquire a harmonic B-mode background image, as previously described.

[0042] One way to significantly increase the flow contrast (i.e., visibility from background) is to use contrast agents in the fundamental mode. Contrast agents are typically encapsulated gas microbubbles between 0.1 and 10 microns in diameter. When introduced into the body through injection, contrast agents serve as high-reflectivity markers for blood flow and perfusion. Ultrasound energy incident on the microbubbles is strongly reflected at the incident (fundamental) frequencies and at resonant (harmonic and subharmonic) frequencies, such that both fundamental and harmonic imaging techniques are used to image contrast agent. The preferred method uses the harmonic frequencies and not the fundamental frequencies within the contrast echoes. Multiple firings of identical pulses are transmitted to a particular transmit focal position in succession. Specifically, N coded pulses centered at a fundamental frequency 𝑓 0 are transmitted to each transmit focal position. On receive, an FIR filter centered at the fundamental frequency compresses the received pulses and substantially isolates the desired fundamental component. Subsequently a wall filter extracts the fundamental flow signal over the N transmits.

[0043] Although only certain preferred features of the invention have been illustrated and described, many modifications and changes will occur to those skilled in the art. For example, the invention is not limited to using biphase codes; polyphase codes can also be used. It is, therefore, to be understood that the appended claims are intended to cover all such modifications and changes as fall within the true spirit of the invention.

[0044] One of the advantages of the disclosure is that the above described embodiments address complaints from sonographers about the inability to visualize tissue background without degrading the fundamental quality of the desired B-flow/CHA/CA image. A second advantage of the disclosure is that the flow image may be displayed by itself for maximum flow contrast, or may be overlayed or side-by-side with a B-mode background image. Superimposition of the flow image on a conventional B-mode image allows the diagnostician to observe the blood flow relative to known anatomical landmarks during medical diagnosis.

[0045] While the invention has been described with reference to a preferred embodiment, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope thereof. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the appended claims. Moreover, the use of the terms first, second, etc. do not denote any order or importance, but rather the terms first, second, etc. are used to distinguish one element from another.