Applications of

Doppler Ultrasound
QURAT-UL-AIN
BS(MIT)
MS(MIT)
Spectral waveform at
the bottom of image,
color Doppler at top.

Sample volume is
placed in the center of
vessel for correct
estimation of laminar
flow.
• Flow Direction
• Flow Pattern
• Flow Velocity
• Low vs. High Flow
• Flow Pattern Within a Vessel (Laminar Flow)
• Flow Distortion
• Flow Changed Beyond a Narrowed Area (Poststenotic changes)
• Flow Volume
• Color Flow Imaging
• Color Flow Display & Direction
BLOOD Flow
Direction
• Flow towards the transducer – above the baseline
• Flow away from the transducer – below the baseline
• Operator’s choice
Clinical Correlation:
• Normal liver flow- hepatopetal (towards liver)
• Reversed in portal HTN- Hepatofugal (away from liver)
Phasicity
• Refers to flow fluctuations due to changing pressure
• Aphasic waveform: no flow, no phase (diseases vessel without flow)
• Non-phasic waveform: flow is present but there is no variations or
fluctuations (diseased veins)
• Phasic: if low level fluctuations are present (veins)
• Pulsatile: when marked fluctuations are present (arteries)
Phasicity can be quantified into monophasic, biphasic, tri and tetraphasic.
It corresponds to the number of phases which are equal to the number of waveform component on either side of baseline.
Unidirectional and bidirectional terms are also used to describe the direction of flow
 Effect of the Doppler angle in the sonogram. (A) higher-frequency Doppler signal is obtained if the beam is aligned more
to the direction of flow. In the diagram, beam (A) is more aligned than (B) and produces higher-frequency Doppler
signals. The beam/flow angle at (C) is almost 90° and there is a very poor Doppler signal. The flow at (D) is away from the
beam and there is a negative signal.
Flow Pattern
• Veins - lower pitched signal
• Arteries – high pitched systolic peak, relatively lower diastolic peak
Clinical Correlation:
• In P-HTN, venous collaterals are formed. It becomes difficult to
distinguish between veins and hepatic artery. These are easily
distinguished using pulsed Doppler.
Flow Changes beyond a Narrowed Area
(Post-stenotic changes)
• Seen in next few cm beyond a narrowed area
• In severe stenosis, systolic peak will be lower, more rounded peak –
tardus et parvus
Clinical Correlation:
• Renal artery stenosis
• Carotid artery stenosis
Flow Velocity
• Flow velocity can be calculated using Doppler equation.
• Only accurate if the angle of sound beam and vessel is less than
60 .
• Velocity error increases as the angle is increased.
Clinical Correlation:
• Severity of carotid stenosis
Low vs. high resistance flow

• High resistance : High systolic peak, low diastolic peak

• Low resistance : Biphasic systolic peak, high diastolic peak
• RI, PI, S/D ratio are used to calculate difference b/w systolic and
diastolic flow

Clinical Correlation:
• In common carotid or renal artery normally there is low resistance flow.
If high resistance waveform is seen in vessel narrowing.
• Ovaries have high resistance flow in proliferative phase, If low
resistance flow is seen within ovarian mass – Most likely carcinoma.
Flow Volume

• Using Doppler equation if

velocity and vessel diameter
are known
Clinical Correlation:
• Low level flow is associated
with inadequate function
Color Flow Imaging
• Gives different colors to RBC’s depending on their direction and
velocities
Clinical correlation:
Site of maximum flow – using pulsed Doppler
Color Flow Display and Direction
• BART
• Faster velocities – bright colors (yellow, white)
• Slower velocities – dark colors
• Turbulent flow – mixture of colors
• Angle dependent
Clinical Correlation:
Soft plaques – flow void maybe seen
Arterial Resistance
Thank you!