Pulsed Doppler imaging of the carotid artery.

Pulsed Doppler imaging (MAVIS, GEC Medical) of the carotid artery in the neck was compared with selective contrast angiography of 50 arteries. All but one of 23 internal carotid arteries with more than 25% stenosis or complete occlusion on angiography were detected by imaging. One of 17 angiographically normal arteries also had an abnormal image. All 16 arteries thought suitable for endarterectomy had abnormal Doppler images. Imaging of the external carotid artery was less reliable and disease of the common carotid artery was too infrequent to allow imaging to be satisfactorily evaluated. This non-invasive technique may eventually replace selective carotid angiography in some patients.

Characterisation of vortex shedding in vascular anastomosis models using pulsed Doppler ultrasound.

Vortex shedding at vascular anastomoses were investigated in vitro using a 20 MHz pulsed-wave Doppler velocimeter. Centreline velocity measurements were made at various axial distances in simplified polyurethane models of proximal and distal end-to-side anastomoses of angles 15, 30, 45, 60 and 80 degrees using pulsatile flow waveforms similar to those in femoropopliteal bypass grafts. The in-phase and quadrature Doppler signals were recorded and the maximum frequency waveform, averaged over 64 cycles, was obtained using short-time Fourier transform. A fourth-order Butterworth low-pass filter was employed to separate the vortex velocity signal from the convective velocity. The vortex signal envelope was calculated using a Hilbert transform method and the vortex amplitude was taken as the maximum of this envelope. The results show that higher vortex amplitude were found in the proximal anastomoses and under resting flow conditions. Although the vortex amplitudes generally increased with angles of anastomosis, they were found to be higher in the 60 degrees than in the 80 degrees proximal anastomosis. The vortex structures were investigated using spectrograms and these show prominent features at 40-50 Hz indicative of the short-duration oscillatory signals during the decelerative phase of systole expected from the passage of vortices. The study indicates that flow disturbances due to vortex shedding may be a common feature in femoropopliteal bypass grafts.

Nonstationarity broadening in pulsed Doppler spectrum measurements.

Conventional measurement of the spectrum of arterial signals from the pulsed ultrasonic Doppler instrument uses windowed, sequential data segments. The Doppler signal is assumed stationary for the duration of each segment. It is shown here that this assumption is often unreasonable and the effect of mean frequency variation during the data segment has been investigated for different windows and rates of change of mean frequency. A data segment length giving maximum spectral resolution is shown to exist for each window type and rate of frequency change.

Comparison of Doppler signal analysis techniques for velocity waveform, turbulence and vortex measurement: a simulation study.

Simulated time-varying Doppler signals incorporating bandwidth, power variation and vortex simulation have been used to compare a number of signal analysis techniques with a view to optimising the accuracy of convective velocity waveform, spectral broadening and vortex signal estimation. The short-time Fourier transform (STFT), the autoregressive (AR) modified covariance estimator, the time-frequency pseudo-Wigner-Ville and Choi-Williams distributions and a partial stationarising algorithm were investigated for a range of some analysis parameters (such as window duration, AR model order). It was found that all methods could estimate the convective velocity waveform well and all the nonclassical methods were an improvement over the STFT for bandwidth estimation with the stationarising method giving the lowest error. For vortex measurement, using parameters that were optimum for mean frequency and bandwidth estimation, the stationarising, modified covariance, pseudo-Wigner-Ville with a 10-ms window and Choi-Williams methods gave improved performances compared with the STFT.

Finite beam-width ray model for geometric spectral broadening.

The purpose of the study was to compare measured spectral width and maximum frequency with that predicted from ray models of geometric spectral broadening. Zero and finite beam-width models were used. Spectral data were acquired from a string phantom using two commonly-used linear array systems. Beam width and Doppler aperture sizes were measured using a needle hydrophone. The results showed that the experimentally measured data agreed best with the finite beam-width model. The zero beam-width model was in error by up to 50% for calculated spectral width, and up to 10% for maximum frequency. It is concluded that spectral width and maximum frequency are best calculated using the finite beam-width model, and that ultrasound manufacturers could improve the variation in spectral broadening measured at different locations on a single machine by adjusting the aperture size to give a constant subtended angle and beam width.

Angle-dependence and reproducibility of dual-beam vector doppler ultrasound in the common carotid arteries of normal volunteers.

Dual-beam vector Doppler has the potential to improve peak systolic blood velocity measurement accuracy by automatically correcting for the beam-flow Doppler angle. Using a modified linear-array system with a split receive aperture, we have assessed the angle-dependence over Doppler angles of 40 degrees -70 degrees and the reproducibility of the dual-beam blood maximum velocity estimate measured in the common carotid arteries (CCA) 1 to 2 cm prior to the bifurcation of 9 presumed-healthy volunteers. The velocity magnitude estimate was reduced by approximately 7.9% as the angle between the transmit beam and the vessel axis was increased from 40 degrees to 70 degrees. With repeat measurements made, on average, approximately 6 weeks apart, the 95% velocity magnitude limits of agreement were as follows: Intraobserver -41.3 to +45.2 cm/s; interobserver -29.6 to +46.8 cm/s. There was an 8.6 cm/s interobserver bias in velocity magnitude. We conclude that the dual-beam vector Doppler system can measure blood velocity within its scan plane with low dependence on angle and with similar reproducibility to that of single-beam systems.

Cost/benefit criterion for selection of pulsed Doppler ultrasound spectral mean frequency and bandwidth estimators.

A flexible selection criterion for spectral estimators based on the weighted statistical accuracy (benefit) of estimation of decisive spectral parameters under the constraint of low computational complexity (cost) is proposed. This new cost/benefit criterion also selects the model order for parametric spectral estimators-selecting model orders significantly lower than those determined by accepted criteria. The importance of different Doppler signal parameters (e.g., mean frequency and spectral bandwidth) and their accuracy of estimation is incorporated by the use of weighting factors. The use of this method with simulated Doppler signals led to the selection of the modified covariance Alt estimator.

Nonstationarity broadening reduction in pulsed Doppler spectrum measurements using time-frequency estimators.

The spectral width of Doppler signals is used as measure of lesion-induced flow disturbance. Its estimation accuracy is compromised using the conventional short-term Fourier transform (STFT) since this method implicitly assumes signal stationarity during the signal window while the Doppler signals from arteries are markedly nonstationary. The Wigner-Ville (WVD), Choi-Williams (CWD) and Bessel distributions (BD), specifically designed for nonstationary signals, have been optimized for spectral width estimation accuracy and compared to the STFT under different signal to noise ratios using simulated Doppler signals of known time-frequency characteristics. The optimum parameter values for each method were determined as a Hanning window duration of 10 ms for the STFT, 40 ms for the WVD and CWD and 20 ms for the BD and dimensionless time-frequency smoothing constant values of five in the CWD and two in the BD. Thresholding was used to reduce the effect of cross terms and side lobes in the WVD and BD. With no added noise the WVD gave the lowest estimation error followed by the CWD. At signal-to-noise ratios (SNR's) of 10 dB and 20 dB the CWD and BD had similar errors and were markedly better than the other estimators. Overall the CWD gave the best performance.

Developments in cardiovascular ultrasound: Part 1: Signal processing and instrumentation.

One of the major contributions to the improvement of spectral Doppler and colour flow imaging instruments has been the development of advanced signal-processing techniques made possible by increasing computing power. Model-based or parametric spectral estimators, time-frequency transforms, station-arising algorithms and spectral width correction techniques have been investigated as possible improvements on the FFT-based estimators currently used for real-time spectral estimation of Doppler signals. In colour flow imaging some improvement on velocity estimation accuracy has been achieved by the use of new algorithms but at the expense of increased computational complexity compared with the conventional autocorrelation method. Polynomial filters have been demonstrated to have some advantages over IIR filters for stationary echo cancellation. Several methods of velocity vector estimation to overcome the problem of angle dependence have been studied, including 2D feature tracking, two and three beam approaches and the use of spectral width in addition to mean frequency. 3D data acquisition and display and Doppler power imaging have also been investigated. The use of harmonic imaging, using the second harmonic generated by encapsulated bubble contrast media, seems promising particularly for imaging slow flow. Parallel image data acquisition using non-sequential scanning or broad beam transmission, followed by simultaneous reception along a number of beams, has been studied to speed up 'real-time' imaging.

Developments in cardiovascular ultrasound. Part 2: Arterial applications.

Many of the changes resulting from arterial disease can be measured, using Doppler ultrasound for measurement of blood velocity and B-scan imaging for measurement of tissue structure and composition. Wall thickness, the degree of arterial narrowing and plaque volume can be measured using B-scan imaging, and 3D ultrasound can be used to improve the accuracy of measurements of plaque volume and for improved visualisation of complex arterial geometries. Measurement of the dynamic properties of the arterial wall permits estimation of wall elasticity and plaque motion. From the Doppler signal, measurements of blood velocity are used to estimate the degree of arterial narrowing and volumetric flow, although measurement errors can be large. Wall shear stress can be estimated by measuring the velocity gradient at the vessel wall. The problems of inadequate spatial resolution and interference from overlying tissue are largely removed when intravascular systems are used, and these have superior capability in the assessment of arterial structure and tissue composition. However, measurement of quantities relating to blood flow is more difficult using the intravascular approach, as the indwelling cather disturbs the blood flow pattern, and currently, assessment of flow and vessel cross-section are not performed at the same site.

Developments in cardiovascular ultrasound. Part 3: Cardiac applications.

Echocardiography is still the principal, non-invasive method of investigation for the evaluation of cardiac disorders. Using Doppler ultrasound, indices such as coronary flow reserve and cardiac output can be determined. The severity of valvular stenosis can be determined by the area of the valve, either directly from 2D echo, from pressure half-time calculations, from continuity equations or from the proximal isovelocity surface area method. Alternatively, the severity of regurgitation can be estimated by colour or pulsed ultrasound detection of the back-projection of the high-velocity jet into the chamber. Myocardial wall abnormalities can be assessed using 2D ultrasound, M-mode or analysis from the radio-frequency-ultrasound signal. Doppler tissue imaging can be used to quantify intra-myocardial wall velocities, and 3D reconstruction of cardiac images can provide visualisation of the complete cardiac anatomy from any orientation. The development of myocardial contrast agents and associated imaging techniques to enhance visualisation of these agents within the myocardium has aided qualitative assessment of myocardial perfusion abnormalities. However, quantitative myocardial perfusion has still to be realised.

Spectrum of Doppler ultrasound signals from nonstationary blood flow.

A new formulation for the Doppler signal generation process in pulsatile flow has been developed enabling easier identification and quantification of the mechanisms involved in spectral broadening and the development of a simple estimation formula for the measured rms spectral width. The accuracy of the estimation formula was tested by comparing it with the spectral widths found by using conventional spectral estimation on simulated Doppler signals from pulsatile flow. The influence of acceleration, sample volume size, and time window duration on the Doppler spectral width was investigated for flow with blunt and parabolic velocity profiles passing through Gaussian-shaped sample volumes. Our results show that, for short duration windows, the spectral width is dominated by window broadening and that acceleration has a small effect on the spectral width. For long duration windows, the effect of acceleration must be taken into account. The size of the sample volume affects the spectral width of the Doppler signal in two ways: by intrinsic broadening and by the range of velocities passing through it. These effects act in opposite directions. The simple spectral width estimation formula was shown to have excellent agreement with widths calculated using the model and indicates the potential for correcting not only for window and nonstationarity broadening but also for intrinsic broadening.

Effect of deviation from plane wave conditions on the Doppler spectrum from an ultrasonic blood flow detector.

Deviation from plane wave conditions within the ultrasound beam of a Doppler blood flow detector leads to a non-linear relationship between the phase angle of the back-scattered signal and the scatterer position. This in turn leads to frequency modulation of the Doppler signal and an increase in the Doppler spectrum width. The relationship between the ultrasound beam and the observed signal spectrum has been investigated by employing a computer-based model of the ultrasound field which enabled the calculation of: 1, pressure (amplitude and phase angle) field distributions from plane disc and focused transducers with unapodized and apodized aperture field distributions; 2, the Doppler signal from a scatterer moving through the field; and 3, the spectrum of this signal. The increase in spectral width resulting from deviations from plane wave conditions was calculated by comparing this spectrum with that of the signal from which frequency modulation had been removed.

Effect of frequency dependent processes on pulsed Doppler sample volume.

The change in the frequency spectrum of ultrasound pulses as a result of frequency dependent attenuation and scatter is known to alter the spectrum of Doppler signals from blood flow parallel to the beam axis. It is shown here that the change in pulse shape accompanying this pulse spectrum change as a result of these processes, together with the velocity dispersion accompanying frequency dependent attenuation and linked to it by the Kramers-Kronig relations, will change the pulsed Doppler sample volume shape and position.

Doppler power spectrum from a Gaussian sample volume.

A closed-form expression for the Doppler power spectrum due solely to the range of blood velocities passing through a Gaussian sample volume placed anywhere in a vessel under conditions of axisymmetric flow, uniform backscatter and negligible intrinsic spectral broadening has been derived. The formulation presented here allows the independent specification of the sample volume position and width, in the three dimensions, and enables simple estimations of spectral shape for pulsed wave Doppler systems. Simpler expressions were derived for the cases of symmetric sample volume projections onto the vessel cross-section and/or sample volumes centred in the vessel. Closed form expressions were derived for mean frequency and spectral width in the case of a symmetric sample volume projection centred in the vessel. The effects of sample volume size and position on the Doppler spectral width and mean frequency are shown for a range of velocity profiles.

Ultrasonic investigation of blood flow.

Ultrasound and the Doppler effect are used to measure blood velocity non-invasively in order to diagnose blood vessel disease. Intrusive lesions on arterial walls give rise to an alteration of the time-varying blood velocity waveform and local blood flow disturbance which are detected and measured using the envelope and width of the Doppler signal spectrogram respectively. Flow may also be imaged in colour superimposed on a grey-scale anatomical image allowing vessel narrowing and the accompanying flow disturbance to be visualized. Developments in three-dimensional imaging, angle tolerant velocity measurements and increased sensitivity using second harmonic backscatter from encapsulated-bubble contrast media ensure increasing use of this modality.

Characterization of vortices using pulsed-wave Doppler ultrasound.

The detection and characterization of vortices from a Kaman vortex generator by means of a 20 MHz pulsed-wave Doppler ultrasound system were assessed. Measurements were made at different steady flowrates in a 10 mm internal diameter polyurethane tube, 14 mm distal to a circular cylinder of diameter 2 mm, placed across the tube inlet. The results were compared with those obtained with a two-component laser Doppler anemometer system. There was generally good agreement between the two techniques in the measurement of convective flow velocity, frequency of vortex shedding and the circulation velocity of the vortices. It is concluded that pulsed-wave Doppler ultrasound is a suitable technique for investigating vortical flow structures.