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Doppler Echocardiography

Joyce Meng M.D.

7/16/2008

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Doppler vs. B-mode Echo-

complemenary roles

!rimary arge is he

red "lood cellE#amine he

direcion$ velociy$ and

paern o% "lood %lo&

hro'gh he hear andhe grea vessels.

!rimary arge are he

myocardi'm and hehear valves

!rovides in%ormaion

a"o' he shape and

movemen o% cardiacsr'c'res.

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('line

Doppler E%%ec

)onin'o's &ave Doppler

!'lse &ave Doppler)olor Doppler

*iss'e Doppler

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)hrisian Doppler

+'sralianmahemaician andphysicis

!'"lished his noa"le&or, on he Dopplere%%ec a he age o%

as regory

Mendels physicspro%essor in heniversiy o% 3ienna.

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Doppler E%%ec

*he pich o% so'nd&as a%%eced "ymoion o&ard or

a&ay %rom he lisener4o'nd moves o&ardhe lisener$ %re5'encyincreases$ pich rises.

4o'nd moves a&ay%rom he lisener$%re5'ency decreases$pich %alls.

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Mahemaical relaionship

:d; Doppler shi%< :=r> received %re5'ency9- :=> ransmied%re5'ency9

:0; *ransmied %re5'ency o% 'lraso'nd

3; velociy o% "lood.

; inercep angle "e&een he inerrogaion "eam and he arge

)an solve %or 3

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hy do &e care a"o' he velociy o%

"lood %lo&?

Modi%ied Berno'llis e5'aion;

!< @v2

ives 's he a"iliy o esimae press're

di%%erences "e&een &o cham"ers i.e$ *9

4enoic valves i.e. +49

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+ngle o% he Doppler "eam

cos (0)= 1cos (10)= 0.98

cos (20)= 0.94

cos (30)= 0.87

cos (60)= 0.5

cos (90)= 0

:d< 2%039cos 9/)

:d 3cos 9

Misalignmen o% he

inerrogaion "eam

&ill lead o

'nderesimaion o%

he r'e velociyBecomes signi%ican

&hen is A20

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)arrier %re5'ency

3

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4pecral analysis

*he di%%erence in &ave%orm"e&een he ransmied and"ac,scaered signal iscompared.

+ process called %as :o'rier

rans%orm ::*9 displays hisin%ormaion ino a Cspecralanalysis specral display o%enire range o% velociies9

*ime- # a#is 3elociy- y a#is

*o&ard he ransd'cer isposiive$ a&ay %rom ransd'cernegaive.

+mpli'de is displayed asC"righness o% he signal.

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)onin'o's &ave doppler

*&o dedicaed crysals- one %or ransmiing andone %or lisening

eceives a conin'o's signal along he enire

lengh o% he 'lraso'nd "eamDisadvanage- don ,no& &here he signal

comes %rom.+dvanage- can meas're very high Doppler

shi%/velociies.Mos 'se%'l &hen rying o discern ma#imal

velociy along a cerain pah +4$ *ec9.

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!ro"lemaic cases

Don ,no& &here he ma#imal velociy comes%rom

4erial senosis- F3(* o"sr'cion or +4?

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!ro"lemaic cases

+4 or M?

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!'lse &ave doppler

4hor inermien "'ss o% 'lraso'nd are ransmied.

(nly Clisens a a "rie% ime inerval

!ermis re'rning signal %rom one speci%ic disance o "e

selecively analyGed- Crange resol'ion

4ample vol'me

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+liasing

4ampling rae is inade5'ae o resolve he direcion o%%lo&

!: p'lse repeiion %re5'ency9- n'm"er o% p'lseransmied %rom he ransd'cer/second

Hy5'is limi< !:/2 )anno resolve higher %re5'ency velociy9 so'nd &aves

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+liasing

*ends o happen a higher velociy es

Doppler shi% is has higher %re5'ency- needs

higher !: o resolve he direcion o% he &ave.

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+liasing

*ends o happen in agreaer deph

4ample vol'me a a

shallo& sie- caninerrogae more%re5'enly higher!:9

4ample vol'me adeeper sie- cannoinerrogae as o%enlo&er !:9

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Iigh !: imaging

4hallo&er sample vol'me associaed &ih a higher !:- less li,ely ohave aliasing

Fisening &indo& &ill also sample re'rning signal %rom &ice ha deph

3elociy %rom "oh sies &ill "e recorded

Disadvanage; am"ig'iy

+dvanage; Iigher velociies can "e analyGed &iho' aliasing

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)olor Doppler

p'lse &ave Doppler &ih m'liple sample vol'me

along m'liple raser lines

direcion$ velociy and variance deermined %or

each sample vol'me

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)olor Doppler

Displayed as color in%ormaion-+mpli'de- inensiy Direcion- red vs "l'e o&ard or a&ay %rom

ransd'cer9

3elociy- "righness "righ "l'e higher velociy9 3ariance 'r"'lence9- coded green o give a mosiac

apperance.(verlays his in%ormaion on 2D images

*ime cons'ming emporal resol'ion is especiallypoor &ih a large secor &indo&9Di%%eren vendors have di%%eren algorihms %or

generaing color Doppler

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E#ample o% )olor Doppler

)olor Doppler e

&ih aliasing in

he cener d'e o

high velociy

)olor Doppler e

encoded &ih

variance

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4emi5'aniaive mehod

mporan o remem"er

ha color codes velociy

and no ac'al vol'me

+ngiography- conras is

ac'al reg'rgiaion

)olor doppler encodes

C"illard "all e%%ec- color

may encode non-

reg'rgian "lood ha isCp'shed aro'nd "y he

reg'rgian e.

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4emi5'aniaive mehod

Meas'res velociy$ no

reg'rgian ori%ice area

(+9

3elociy can "e inversely

proporional o (+

Farger (+ may lead o

lo&er velociy

Je loo,s smaller han a

hose &ih smaller (+.

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)olor gain

4ame e &ih di%%eren

color gain appears

di%%eren.

)olor gain is 'rns 'p

or do&n he

ampli'de o% he color

e.

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)olor gain

*o opimiGe color gain$

'rn i 'p 'nil yo' see

spec,les in he iss'es-

hen 'rn i do&n

slighly

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)olor scale/ Hy5'is limi

By changing he color

Hy5'is limi$ he e

appearance and siGe

can appear di%%eren

4ho'ld se he Hy5'islimi o he highes a

given deph allo&s

generally A0.6 cm/s9

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)olor Doppler M-mode imaging

!'lse Doppler inerrogaion done along a

single line

Doppler velociy shi% recorded and color

coded

!rovides high emporal and spaial "'

sill no velociy9 resol'ion o he

assessmen o% %lo&

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)olor Doppler M-mode

4mall amo'n o% le% o righ %lo& d'ring

sysole

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*iss'e Doppler maging

o'ine Doppler arges "lood %lo&Iigh velociy

Fo& signal ampli'de

*iss'e Doppler assessing he movemen

o% he myocardi'm9 arges iss'e Fo& velociy

Iigh signal ampli'de

Di%%eren :ilers

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E#ample o% p'lse *D

3elociy o% iss'e along a paric'lar sample vol'me

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E#ample o% )olor *D

3elociy o% iss'e coded "y color s'perimposed on 2-D image

)an derive in%ormaion s'ch as srain$ srain rae$ dyssynchronyec.