To review and summarize the problems of myocardial contrast echocardiography (MCE) image sequences.

We retrospectively analyzed MCE image sequences of a total of 133 patients with 553 apical view images at Renmin Hospital of Wuhan University from June 2021 to December 2021, including 181 apical four-chamber view (A4C), 181 apical two-chamber view (A2C), and 191 apical three-chamber view (A3C) images. The incidence of various image problems in the three apical view image sequences was counted. The chi-square test was used for comparison of the incidence of image quality problems in the three apical view image sequences. The image problems were classified as: excessive and too low intracardiac contrast medium concentration, rib/lung occlusion, substandard flash, and too high and low gain.

The incidences of excessive and too low intracardiac contrast medium concentration, rib/lung occlusion, substandard flash, and too high and low gain were 12.12% (67/553), 9.76% (54/553), 13.92% (77/553), 19.53% (108/553), 6.33% (35/553), and 2.17% (12/553), respectively. The incidence of excessive intracardiac contrast medium concentration was highest in the A4C sequence, which was first acquired during the examination (A4C vs A2C vs A3C: 18.23% vs 8.29% vs 9.95%, χ²=9.694, P=0.008); the incidence of too low intracardiac contrast medium concentration was lower in the A2C sequence compared to the A4C sequence, but the difference did not reach statistical significance (A4C vs A2C vs A3C: 8.84% vs 12.71% vs 7.85%, χ²=2.746, P=0.253); a higher proportion of rib/lung obscuring acoustic images occurred in the A2C and A3C sequences compared to the A4C sequence (A4C vs A2C vs A3C: 3.87% vs 19.89% vs 17.80%, χ²=23.043, P＜0.001).

In MCE examination, A4C images captured during the bolus injection process are prone to excessive intracardiac contrast medium concentration, while A2C and A3C images are prone to rib/lung occlusion. Unqualified flash is in high percentage and should be avoided during examination.