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There are several commercially available microbubbles throughout the world. Although their primary indications are for either improving left ventricular opacification or enhancing liver imaging, these agents have also been used clinically for off-label applications, such as myocardial and tumor perfusion imaging.1,2 The reason such practices are permissible is that these applications provide critical additional clinically useful information with the same doses of microbubbles required for the approved indication, and the imaging techniques required to perform these off-label applications are available on almost all commercially available scanners. To get Food and Drug Administration approval for any new indication or modification of the microbubble in the United States, additional expensive clinical trials and safety data (in the case of microbubble shell modifications) would be required. This becomes especially problematic for targeted molecular imaging applications with microbubbles, where specific ligands must be attached to microbubbles in order for them to be retained at sites where receptor upregulation occurs in …

Detection of Myocarditis With Molecular Echo Imaging