Scribd
Upload
6 views8 pages

Basics of Doppler Ultrasound For The Nephrologist Part2

This document discusses spectral Doppler ultrasound, focusing on its ability to measure blood flow velocity and analyze waveforms for hemodynamic assessment. It explains the two main types of spectral Doppler: pulsed-wave (PW) and continuous-wave (CW), detailing their functionalities, advantages, and limitations. Additionally, it covers concepts like angle correction and aliasing, which are crucial for accurate interpretation of Doppler ultrasound results.

Uploaded by

Vane Roglev
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
6 views8 pages

Basics of Doppler Ultrasound For The Nephrologist Part2

This document discusses spectral Doppler ultrasound, focusing on its ability to measure blood flow velocity and analyze waveforms for hemodynamic assessment. It explains the two main types of spectral Doppler: pulsed-wave (PW) and continuous-wave (CW), detailing their functionalities, advantages, and limitations. Additionally, it covers concepts like angle correction and aliasing, which are crucial for accurate interpretation of Doppler ultrasound results.

Uploaded by

Vane Roglev
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 8

Basics of Doppler Ultrasound for the Nephrologist- Part 2

December 7, 2020
22203866

In the previous post, we talked about the Doppler effect, color flow and power Doppler
modes. Now let us focus on the spectral Doppler. Spectral Doppler enables us to
measure the velocity of blood flow as well as analyze the waveform (graphical
representation of velocity over time), both of which are important in hemodynamic
assessment.

The spectral waveform is displayed above the baseline if the flow is towards the
transducer (analogous to red in color Doppler) and below the baseline if the flow is
away from the transducer (blue in color Doppler) [Figure 1]. Figure 2 is an example of a
waveform which is both above and below the baseline, which means there is to-and-fro
blood flow pattern. This hepatic vein tracing was obtained from a patient with severe
tricuspid regurgitation, where blood was being pushed back by the regurgitant jet into
the hepatic vein (towards transducer) during systole and going into the heart during
diastole (away from the transducer).

There are two main types of spectral Doppler – pulsed-wave (PW) Doppler and
continuous-wave (CW) Doppler.

Figure 1. Spectral Doppler waveforms


Figure 2. Spectral Doppler waveforms- hepatic vein in tricuspid regurgitation
1. PW Doppler
In PW Doppler mode, the transducer sends out the ultrasound waves, waits and listens
to the reflected echoes (‘pulsed’ transmission). The number of ultrasound pulses emitted
by the transducer per unit time is called pulse repetition frequency (PRF). As every
emitted pulse is paired with a returning signal, it is possible to determine the
depth/location of the reflector (RBC). That means, using PW Doppler, you can choose
the exact location where you want to measure the velocities (e.g. just the center of a
large vessel, just at the mitral valve leaflets etc.). When you press the PW button on the
machine, a Doppler line appears on the screen with an opening called the Doppler gate
or sample volume, whose width can be adjusted as needed [Figure 3]. When this gate is
placed in the region/blood vessel of interest, the spectral waveform is displayed.
Depending on what vessel you are imaging and the nature of the waveform, various
parameters can be calculated such as peak-systolic velocity, end-diastolic velocity,
pulsatility index etc.
Figure 3. Pulsed wave doppler
Angle correction

As mentioned in the previous post, the Doppler shift depends on the angle of insonation.
Ideal angle is 0 degrees (parallel to flow) to get maximum Doppler shift but less than 60
degrees is acceptable (error significantly increases after that). Figure 4 illustrates how
angle changes the displayed velocities. Improper angle leads to erroneous interpretation
(e.g. when assessing AV access stenosis). In addition to beam steering, angle correction
cursor can be used to manually adjust the angle (= a small movable line that appears at
the sample volume). This is typically aligned parallel to the vessel wall [Figure 5]. Newer
ultrasound machines have an auto-correction feature. Good news is that if your purpose
is to just analyze the shape of the waveform or calculate fractions and do not need
absolute velocities (e.g. renal resistive index), angle correction is not that important
(saves time at the bedside).
Figure 4. Influence of angle of insonation on spectral waveform

Figure 5. Pulsed wave doppler tracing of portal vein


Aliasing

This is an important characteristic of PW Doppler that you need to be aware of. As the
same transducer element is used to send and receive ultrasound pulses (= cannot listen
continuously), there is a limit on the maximum velocity that can be detected. Particularly
happens with deeper structures (= returning echoes take longer and the transducer is in
the process of sending out next pulse before the previous echoes return completely –
flow direction will be misread by the machine). When this happens, top portions of the
waves are chopped off and displayed on the opposite side of the baseline. This is called
aliasing [Figure 6]. This can be overcome by (1) increasing the scale [= PRF] and/ (2)
lowering the baseline. Figure 7 illustrates how aliasing disappears by doing these two
things. If nothing helps (e.g. velocity is too high), switch to CW Doppler.

Figure 6. Aliasing

Figure 7. Aliasing disappears with scale increased and baseline lowered


Aliasing can also be seen on color flow Doppler as mixture of colors when the scale is
set too lower than expected for a particular vascular bed. This can be misinterpreted as
turbulence due to stenosis. Figure 8 is a nice example showing the transition to uniform
red color from mixture of colors as we increase the scale (left of the image) from 5 cm/s
to 25 cm/s.

Figure 8. Transition to uniform red color from mixture of colors


• CW Doppler
This mode utilizes two separate transducer elements – one to transmit the ultrasound
waves and the other one to listen to the reflected echoes. As it can continuously listen to
the returning signal, this mode is free of aliasing and displays more accurate velocity
information. However, it is NOT spatially precise – meaning measures blood flow
velocities along the entire ultrasound beam. The CW Doppler line/cursor does not have
a gate/sample volume. It is used to measure high velocities that PW Doppler cannot
accurately measure, such as trans-valvular gradients (e.g. tricuspid regurgitation signal
to measure RVSP; aortic stenosis etc.) [Figure 9].
Figure 9. Continuous wave doppler
• Tissue Doppler imaging (TDI) or tissue velocity imaging (TVI)
This can be considered a type of PW Doppler that is used to measure the movement of
tissue (typically myocardium) instead of blood. Used in echocardiographic applications
such as measuring the mitral annular movement to evaluate left ventricular filling
pressures. The velocity scale is very low compared to blood flows in the heart. When
you turn on this mode, a color flow mapping of the heart appears (the heart walls light
up; not blood). Then you press the PW button and place the sample volume at the
region of interest. Mitral annular tracing is shown in figure 10. Description of these
waveforms/filling pressure estimation is beyond the scope of this post and will be
discussed in the future along with other pertinent Doppler applications.
Figure 10. Mitral annular tracing
Abhilash Koratala, MD (@NephroP)
Medical College of Wisconsin

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy