Zhang, G.; Leroy, H.; Rideau, B.; Reygrobellet, A.; Pernot, M.; Deffieux, T.; Ialy-Radio, N.; Pezet, S.; Tanter, M.

Microbubble contrast-enhanced ultrasound (CEUS) relies on discriminating nonlinear bubble signals from linear tissue backscattering. While Singular Value Decomposition (SVD) filtering improves this discrimination, existing techniques often fail to retain the slowly-moving microbubble signals from static clutter. Here, we present a novel multi-stage singular value decomposition (MS-SVD) framework for ultrafast CEUS imaging. Our method employs plane-wave transmissions at multiple angles and acoustic pressure levels (implemented via duty-cycle modulation) and alternating transmit polarity. The beamformed data are then processed by three sequential SVD filters: (1) spatial-angular SVD to extract coherent signals across all transmit angles, (2) spatial-pressure SVD to separate linear fundamental and nonlinear harmonic components, and (3) spatiotemporal SVD to isolate moving microbubble echoes from tissue clutter. In in vitro flow phantoms and in vivo rat brain through a cranial window, MS-SVD dramatically improves microbubble detection compared to conventional SVD filtering, MS-SVD yields much stronger vascular contrast and suppresses tissue clutter to a greater extent. The resulting power-Doppler and super-resolution maps are notably cleaner and more complete: MS-SVD detects substantially more microbubble events in ULM, revealing finer vessel details and more accurate flow speeds. By capturing the full acoustic signature of microbubbles (both fundamental and harmonic), MS-SVD achieves higher contrast-to-noise and sensitivity in CEUS. These gains make it a powerful front-end for super-resolution ultrasound localization microscopy and other high-sensitivity microvascular imaging applications.