Doppler Echocardiography

Joyce Meng M.D.

7/16/2008

Doppler vs. B-mode Echocomplementary roles

Primary

target is the
red blood cell
Examine the
direction, velocity, and
pattern of blood flow
through the heart and
the great vessels.

Primary

target are the

myocardium and the
heart valves
Provides information
about the shape and
movement of cardiac
structures.

Outline
Doppler

Effect
Continuous wave Doppler
Pulse wave Doppler
Color Doppler
Tissue Doppler

Christian Doppler
Australian

mathematician and
physicist
Published his notable
work on the Doppler
effect at the age of 39
Was Gregory
Mendels physics
professor in the
University of Vienna.

Doppler Effect
The

pitch of sound
was affected by
motion toward or
away from the listener
Sound moves toward
the listener, frequency
increases, pitch rises.
Sound moves away
from the listener,
frequency decreases,
pitch falls.

Doppler effect applied to

Echocardiography

Transducer emits
ultrasound reflected from
RBC.
If RBC (flow of blood)
moves toward transducer,
frequency of the reflected
sounds wavelength
increases
If RBC (flow of blood)
moves away from the
transducer, frequency of
the reflected sounds
wavelength decreases

Mathematical relationship

Fd: Doppler shift= F[r] (received frequency)- F[t] (transmitted

frequency)
F0: Transmitted frequency of ultrasound
V: velocity of blood.
: intercept angle between the interrogation beam and the target
Can solve for V=Fd(C)/2f0(cos

Why do we care about the velocity of

blood flow?
Modified
P=

Bernoullis equation:

4v2

Gives

us the ability to estimate pressure

differences between
two

chambers (i.e, TR)

Stenotic valves (i.e. AS)

Angle of the Doppler beam

Fd=

2f0(V)(cos )/C

V(cos )
Misalignment of the
interrogation beam
will lead to
underestimation of
the true velocity
Becomes significant
when is >20
Fd

cos
cos
cos
cos
cos
cos

(0)= 1
(10)= 0.98
(20)= 0.94
(30)= 0.87
(60)= 0.5
(90)= 0

Carrier frequency

V=Fd(C)/2f0(cos )
If Fd stays the same, the lower the f0 (carrier frequency),
the higher the velocity of the jet that can be resolved.
Unlike B-mode imaging where higher frequency
transducer gives better resolution, here lower frequency
transducers gives better resolution.

Spectral analysis

The difference in waveform

between the transmitted and
backscattered signal is
compared.
A process called fast Fourier
transform (FFT) displays this
information into a spectral
analysis (spectral display of
entire range of velocities)
Time- x axis
Velocity- y axis
Toward the transducer is
positive, away from transducer
negative.
Amplitude is displayed as
brightness of the signal.

Continuous wave doppler

Two

dedicated crystals- one for transmitting and

one for listening
Receives a continuous signal along the entire
length of the ultrasound beam
Disadvantage- dont know where the signal
comes from.
Advantage- can measure very high Doppler
shift/velocities.
Most useful when trying to discern maximal
velocity along a certain path (AS, TRetc).

Clinical example- AS
The

position of the
doppler beam is 2-D
guided.
In the GE system, its
indicated by a single
line
Profile is usually filled
in- velocity along the
path that is below the
maximal velocity also
represented.

Problematic cases

Dont

know where the maximal velocity comes

from
Serial stenosis- LVOT obstruction or AS?

Problematic cases

AS

or MR?

Pulse wave doppler

Short intermittent busts of ultrasound are transmitted.

Only listens at a brief time interval
Permits returning signal from one specific distance to be
selectively analyzed- range resolution
Sample volume

Clinical Examples

position of doppler beam

2-D guided
In GE system, the sample
volume is indicated by
double lines
Spectral envelope not
filled in
Common use- mitral
inflow velocity and LVOT
velocity

Aliasing

Sampling rate is inadequate to resolve the direction of

flow
PRF (pulse repetition frequency)- number of pulse
transmitted from the transducer/second
Nyquist limit= PRF/2
Cannot resolve higher frequency (velocity) sound waves

Aliasing

Tends

to happen at higher velocity jets

Doppler shift is has higher frequency- needs
higher PRF to resolve the direction of the wave.

Aliasing
Tends

to happen in at
greater depth
Sample volume at a
shallow site- can
interrogate more
frequently (higher
PRF)
Sample volume at
deeper site- cannot
interrogate as often
(lower PRF)

High PRF imaging

Shallower sample volume associated with a higher PRF- less likely to

have aliasing
Listening window will also sample returning signal from twice that depth
Velocity from both sites will be recorded
Disadvantage: ambiguity
Advantage: Higher velocities can be analyzed without aliasing

Color Doppler
pulse

wave Doppler with multiple sample volume

along multiple raster lines
direction, velocity and variance determined for
each sample volume

Color Doppler
Displayed

as color information-

Amplitude- intensity
Direction- red vs blue (toward or away from
transducer)
Velocity- brightness (bright blue higher velocity)
Variance (turbulence)- coded green to give a mosiac
apperance.

Overlays

this information on 2D images

Time consuming (temporal resolution is especially
poor with a large sector window)
Different vendors have different algorithms for
generating color Doppler

Example of Color Doppler

Color Doppler jet
encoded with
variance

Color Doppler jet

with aliasing in
the center due to
high velocity

Semiquantitative method

Important to remember
that color codes velocity
and not actual volume!
Angiography- contrast is
actual regurgitation
Color doppler encodes
billard ball effect- color
may encode nonregurgitant blood that is
pushed around by the
regurgitant jet.

Semiquantitative method

Measures velocity, not

regurgitant orifice area
(ROA)
Velocity can be inversely
proportional to ROA
Larger ROA may lead to
lower velocity
Jet looks smaller than a
those with smaller ROA.

Color gain
Same jet with different
color gain appears
different.

Color gain is turns up

or down the
amplitude of the color
jet.

Color gain
then turn it down
slightly

To optimize color gain,

turn it up until you see
speckles in the tissues-

Color scale/ Nyquist limit

Should set the Nyquist
limit to the highest a
given depth allows
(generally >0.6 cm/s)

By changing the color

Nyquist limit, the jet
appearance and size
can appear different

Color Doppler M-mode imaging

Pulse

Doppler interrogation done along a

single line
Doppler velocity shift recorded and color
coded
Provides high temporal and spatial (but
still not velocity) resolution to the
assessment of flow

Color Doppler M-mode

Small amount of left to right flow during

systole

Tissue Doppler Imaging

Routine

Doppler targets blood flow

High

velocity
Low signal amplitude
Tissue

Doppler (assessing the movement

of the myocardium) targets tissue
Low

velocity
High signal amplitude
Different

Filters

Example of pulse TDI

Velocity of tissue along a particular sample volume

Example of Color TDI

Velocity of tissue coded by color superimposed on 2-D image

Can derive information such as strain, strain rate, dyssynchronyetc.