The Doppler signal: where does it come from and what does it mean?

Doppler sonographic measurement of blood velocity and associated physiologic parameters is a powerful diagnostic technique. State-of-the-art instrumentation incorporates velocity measurement with two-dimensional imaging capability; it uses intensity and color coding to display complex physiologic and anatomic data to the observer in an easily understood format. Although the concepts underlying Doppler sonography are not complex, mastery of the technique requires extra training and commitment. The principal features and clinical practicalities associated with Doppler sonography are summarized in the following paragraphs. Continuous-wave Doppler is very sensitive to small vessels and has no upper velocity limit. In addition, the instrumentation is not complex and produces relatively low acoustic power. A significant drawback to continuous-wave Doppler is that there is no depth sensitivity, and thus complex structures or multiple vessels can give conflicting information. Pulsed Doppler (including duplex and color-flow) instrumentation has the capability of depth resolution and a variable sample volume. Pulsed Doppler equipment is prone to aliasing (false velocity indications) under some circumstances and also produces higher peak power levels than does continuous-wave equipment. Duplex equipment is more complex and expensive than continuous-wave equipment because the two-dimensional and Doppler modes must be synchronized in operation and display. Color-flow equipment is extremely complex and expensive. Color flow provides information of a qualitative and limited quantitative value. Absolute measurement still requires range-gate measurements. Technical and anatomic factors will affect the measured velocity profiles. Thus, it is important to fully appreciate the anatomy of the vessel and the angle between the vessel and the ultrasound beam when making quantitative measurements. Measurements that evaluate the velocity waveform and make use of ratios, such as the pulsatility index, eliminate the need for angular corrections; however, artifacts due to unappreciated anatomic or wall characteristics may lead to incorrect information if all parameters are not fully understood. Doppler sonographic measurements may be used to determine the presence of flow, determine the direction of flow, identify time-varying velocity characteristics, and detect velocity disturbances. Because flow and velocity are related, it is possible to estimate flow from velocity measurements with careful calibration and proper precautions. Velocity is related to flow, which, in turn, is related to both pressure and vascular resistance.(ABSTRACT TRUNCATED AT 400 WORDS)