: Spectral and Color

Doppler Artifacts1
Myron A. Pozniak, MD
James A. Zagzebski, PhD
KatbleenA. Scanlan, MD

Artifacts in spectral and color Doppler imaging can be confusing and

lead to misinterpretation of flow information. The authors review
these artifacts by considering three main causes: inappropriate equip-
ment settings, anatomic factors, and physical and technical limitations
of the modality. Incorrect gain, wall-filter, or velocity scale settings can
cause loss of clinically important information or distortion of the trac-
ing. Reflection of the Doppler signal from highly reflective surfaces
can create a color Doppler mirror image. Vascular motion can intro-
duce artifactual variation in velocity as the sample volume passes
through different velocities in a laminar flow state. Unintentional mo-
tion can cause a generalized Doppler shift. Increasing the angle of
Doppler interrogation degrades the quality of the tracing and gives
the impression of spectral broadening. As angulation approaches 900
directional ambiguity can occur, suggesting bidirectional flow. Grat-
ing and side lobes can interrogate areas unrelated to the sample vol.
ume and introduce extraneous Doppler information to the apparent
area of interrogation. Recognition of these artifacts is essential to
proper interpretation of Doppler information and rendering a correct
diagnosis.

U INTRODUCTION
Doppler evaluation of hemodynamics provides useful clinical information. The pres-
ence or absence of flow in a vessel, flow direction, pulsatility, and velocity can all be
studied with this modality. In addition, color Doppler provides a visual image of the
flow characteristics, profiling regions of turbulence. With both modalities, correct
interpretation of tracings and flow images requires knowledge of physical and tech-
nical factors that influence Doppler signals. Artifacts caused by physical limitations
of the modality or inappropriate equipment settings can result in displayed flow
conditions that may differ considerably from the actual physiologic situation. Under-
standing limiting factors and appropriately modifying instrument settings should
minimize misdiagnosis.
In this article, we review artifacts in spectral and color Doppler imaging. We have
grouped them into three categories: those resulting from inappropriate equipment

Index terms: Ultrasound (US), artifact #{149}

Ultrasound (US), Doppler studies

RadloGraphics 1992; 12:35-44

I From the Department of Radiology, University ofWisconsin Hospital and Clinics, 600 Highland Ave. Madison, WI
53792 (M.A.P.,J.A.Z., K.A.S.), and the Department ofMedical Physics, University ofWisconsin, Madison (J.A.Z.). Recipi-
ent ofa Certificate ofMerit for a scientific exhibit at the 1990 RSNA scientific assembly. Receivedjune 10. 1991; revision
requested August 23 and received September 24; accepted September 26. Supported in part by a grant from Radiation
Measurements, Middleton, Wisconsin. Address reprint requests to M.A.P.
‘ RSNA, 1992

35
 a. b.
Figure 1. Images were generated of a common
sonographic gray-scale phantom. Transducer was
moved back and forth across the phantom to gener-
ate a Doppler shift. (a) With proper gain settings, a
clear distinct velocity envelope is displayed. Flow
manifests in a uniform direction with a window un-
der the systolic peak indicating a narrow range of
velocities at any point in time. (b) With a moderate
increase in gain, the velocity tracing is thickened,
that is, the spectrum broadens (*). Systolic window
becomes filled in (**). Additionally, a mirror image
tracing that suggests reversed flow is also displayed
(arrow). (c) Further increase in gain produces
spikes over the tracing where the detection circuitry
is overwhelmed by the higher velocity shifts. rn/s =
meters per second.

settings, those arising from anatomic factors, tive to the transducer, flow velocity, and im-
and artifacts related to physical and technical portant flow conditions such as turbulence
limitations of the modality. Phantom and clini- are inferred from this display.
cal examples are shown in both color flow Most color flow instruments derive a flow
imaging and spectral Doppler. image by applying Doppler signal processing
and detection to the echo signal waveform
U DOPPLER SIGNAL and then estimating the mean Doppler fre-
Doppler processing detects phase or fre- quency at multiple locations along each beam
quency shifts in returning echo signals when line (1). Different methods are used by manu-
there is relative motion between scatterers facturers for this estimation. All methods re-
and the ultrasound
transducer. The Doppler quire a series ofperhaps eight to 15 pulse-
equation,f,) 2f)Vcos(O)/c,
= gives the magni- echo sequences along each beam line to
tude of the frequency shiftJ) when reflectors obtain sufficient data for estimating the mean
are moving with velocity V and angle 0 relative Doppler frequency within each pixel. This
to the ultrasound beam.f, is the ultrasound prolonged data acquisition time reduces the
frequency, and c is the speed of sound in the frame rate below that of conventional B-mode
medium. In addition to an audio presenta- imaging and introduces trade-offs between
tion, frequency (or spectral) analysis is pre- color image quality, image size, and temporal
sented as a tracing of Doppler frequency dis- resolution. The color image portrays mean
tribution versus time. This display may also be flow velocity and direction relative to the
presented in terms of velocity by solving the transducer for pixels throughout the targeted
above equation for V. Direction of flow rela- field.

36 U RadioGraphic-s U Pozniak Ct a! Volume 12 Number 1

a. b.
Figure 2. (a) Color Doppler image of a portal vein fails to show flow within the lumen. Color adjacent to
the portal vein represents the hepatic artery. False diagnosis of thrombosis was considered. (b) Image ob-
tained with the color scale adjusted downward (arrow) demonstrates normal flow.

U ARTIFACTS RELAThD TO . Velocity Scale Errors and Aliasing

INAPPROPRIATE SETfINGS In both spectral Doppler and color flow imag-
ing, the velocity scale setting is crucial to a
. Doppler Gain Setting Errors successful display of signals. For example,
Proper gain setting in B mode is critical to an low-flow detectability is affected by the veloc-
accurate image; it is also critical in Doppler ity setting. When the velocity range is set too
processing for accurate depiction of flow high, low-flow states might not be displayed;
characteristics. If the gain setting is too low, for example, a patent vessel may appear
valuable flow information may be lost. The thrombosed (Fig 2). Conversely, when the
sonographer frequently adjusts the gain to velocity scale is set too low for the flow condi.
maximize visualization of the spectral tracing. tions present, aliasing occurs. This phenome-
A gain setting that is too high, however, de- non is related to the fact that spectral Doppler
grades the velocity envelope on the spectral and color flow use pulsed sound beams. If the
display. This mimics spectral broadening and frequency of the Doppler signal exceeds the
gives the impression, for example, of post- Nyquist sampling rate (ie, onehalf the pulse
stenotic turbulence. A mirror image spectral repetition frequency), ambiguous or aliased
tracing can occur if the directional circuitry is signals are produced. The spectral tracing typ-
overwhelmed. At higher velocities, spikes of ically shows a wraparound effect. By increas-
noise project across the tracing and degrade it ing the Doppler angle (which decreases Dop-
(Fig 1). pler shift), increasing the velocity scale (which
Gain setting errors in color Doppler are also increases the pulse repetition frequency),
usually obvious. It is appropriate to set the changing the baseline setting, or using a
color gain by turning it up until noise is en- lower ultrasound frequency, aliasing can be
countered and then backing off until the avoided (Fig 3).
noise just clears from the image. When the Color aliasing projects the color of reversed
gain setting is too high, the image becomes flow within central areas of higher laminar
cluttered with color noise in a random pat- velocity. The key to perceiving color aliasing
tern. When the gain is set too low, Doppler with most equipment is the fact that there is
shifts are not displayed in vessels, especially no black stripe from the low-velocity filter be-
those with relatively slow flow. tween the reversed colors (Fig 4) (2).

January 1992 Pozniak Ct a! U RadioGraphic-s U 37

 Figures 3, 4. (3a) On Doppler image obtained with the velocity scale set too low (arrows), aliasing occurs,
and the higher velocity systolic peaks wrap around to project below the baseline. (3b) By adjusting the scale
setting, the systolic component is correctly displayed. rn/s = meters per second. (4a) Blue and green colors
within the central portion of the vessel suggest flow reversal, but they are actually secondary to aliasing of
the higher central velocities. Slower velocity near the wall is displayed in the proper direction. With aliasing,
the wraparound occurs from the top to the bottom of the scale bar and does not go across the (black) wall.
motion filter (arrow in a); therefore, no black stripe is noted between the display ofthe two different color
directions. This is in contrast to the image with true flow reversal (cf Fig 10). (4b) By adjusting the color
scale, flow direction is now correctly displayed.

#{149}
Incorrect Wail-Filter Setting U ANATOMICALLY RELATED
Filtration is designed to remove unwanted ARTIFACTS
low-frequency Doppler signals originating
from slowly moving soft-tissue reflectors. The #{149}
Mirror Image Artifact
cutoff frequency is operator selectable. With Mirror image artifacts are commonly observed
filtration set too high, diagnostically signifi- in conventional B-mode imaging (3). A similar
cant velocity information can be lost (2). This artifact can occur with color Doppler imaging
is especially true in low-flow states and in the of any vessel adjacent to a highly reflective
measurement of resistive index (Fig 5). surface, such as the lung (4). The subdia-
phragmatic region of the liver and the supra-
clavicular region are most notorious for this
artifact (Fig 6) (5,6).

38 U RadioGraphic-s U Pozniak Ct a! Volume 12 Number 1

 Figure 5. Spectral Doppler tracing ofa normal arte-
rial waveform. As filtration is increased across this
tracing from left to right (arrows), the lower velocity
components become obliterated. Increased filtration
can eliminate low-velocity diastolic flow and yield an
impression of higher flow resistance. rn/s = meters
per second.

Figure 6. (a) Image of the supraclavicular region shows two apparent subclavian veins. The more anterior
vessel is the true vein. The deeper vessel below the pleura (arrows) is actually an artifactual mirror image
reflecting off the lung apex. (b) Longitudinal image of the inferior vena cava. A second vessel is perceived
deep to the true inferior vena cava (arrows). Doppler shift is more prominent in the mirrored vessel. As the
sound beam reflects from the diaphragm, it interrogates the inferior vena cava flow at less of an angle,
thereby undergoing a greater Doppler shift than when it interrogates the true vessel, which is more perpen-
dicular to the ultrasound beam. (c) Schematic shows the course of the true signal (large arrows) and the mir-
rored signal (small arrows). Increased distance that the mirrored signal travels causes the phantom vessel to
project deeper in the image.

January 1992 Pozniak et a! U RadioGraphic-s U 39

 Figure 7. (a) Normal portal vein flow is usually at a uniform velocity toward the liver. This portal vein trac-
ing was obtained in a normal volunteer during suspended respiration. With a small sample volume centrally
positioned in the vessel, the spectral Doppler tracing reveals a pulsatile waveform. (b) With Doppler sample
volume slightly enlarged, orientation of the transducer relative to the vessel altered, and sample volume po-
sitioned more laterally in the vessel, pulsatility has almost completely resolved. This is due to decreased ex
cursion between areas of differing velocities within the vessel and a larger cross-sectional sampling. rn/s =
meters per second. (c) Pulsatile flow in a flow phantom was generated. Image captures the onset ofthe pulse
waveform across the interrogated region. Propagating wave assumes a parabolic form revealing the laminar
flow profile. (d) Positioning a velocity tag (green) in the middle velocity range demonstrates laminar profile
of flow in the portal vein. Slowest velocities adjacent to the vessel wall are darker red; middle velocities are
green; and highest velocities, which are light pink, are found centrally within the vessel.

#{149}
Vascular-Motion Artifact velocity peripheral flow and back. This can
When a vessel that is moving relative to the introduce or increase periodicity of the portal
transducer is interrogated, artifactual pulsatil- venous flow pattern, an appearance sugges-
ity can be introduced into the spectral tracing. tive of, for example, tricuspid regurgitation.
This artifact can be perceived in the portal Increasing the size of the Doppler gate to in-
vein and its branches. Transmitted cardiac elude the entire vessel, imaging other portal
contraction pushes on the liver and tugs on branches, or varying the angle may decrease
the inferior vena cava. This rocking action of this artifact (Fig 7).
the liver causes slight motion of the vessels
with respect to the Doppler sample volume. #{149}
Color in Nonvascular Structures
Even a small degree of motion is sufficient to An area of low echogenicity such as a cyst or a
displace the sample volume from the higher- duct is susceptible to color flash artifact. Any
velocity central laminar flow to the slower- motion of a reflector relative to the trans-
ducer produces a Doppler shift. Most color
flow processors incorporate motion discrimi-
nators that separate true flow from random

40 U RadioGraphic-s U Pozniak Ct a! Volume 12 Number 1

 Figure 8. Image of a gallbladder obtained during
suspended respiration. Transducer motion intro-
duced color flash artifact in the image, but it preferen-
tially dominates the hypoechoic areas.

Figure 9. (a) Portal vein flow 90#{176}

perpendicular to the Doppler beam. Sample volume was placed over that
portion of the vessel where it passes perpendicular to the interrogating beam. Doppler shift is perceived;
however, it is displayed equally above and below the spectral baseline. (b) By altering the angle of in-
sonation away from 90#{176}, the direction of flow is correctly displayed and the velocity envelope is better de-
fined. rn/s = meters per second.

motion of soft-tissue reflectors. However, the they usually manifest as a tracing both above
lower level signals arising from hypoechoic and below the spectral baseline. At higher
soft-tissue regions less effectively trigger the gain settings, directional ambiguity is worse
motion discriminator and do not suppress the and the velocity envelope on the spectral trac-
resultant color flash. Even minute motion may ing becomes more indistinct. The ambiguity is
produce artifactual color signals within di- easily corrected when the interrogating beam
lated bile ducts, cysts, or the gallbladder (Fig direction is shifted to an angle at either side
8). This can be erroneously perceived as flow, of 90#{176}
(Fig 9). When the sample volume is po-
especially if the color sensitivity settings are sitioned on a sector image, care should be
high (7). taken to avoid that portion of a vessel that
intercepts the interrogating beam at 90#{176}.
With
U INSTRUMENT- AND a linear transducer, electronic angulation or
PROCESSOR-RELATED ARTIFACTS wedge standoffs can improve the angle of
spectral Doppler interrogation (8).
#{149}
Directional Ambiguity
Directional ambiguity can result when the
interrogating beam intercepts the vessel at a
90#{176}
angle. If Doppler signals are detected,

January 1992 Pozniak Ct a! U RadioGraphic-s U 41

 . Sector color b image of a
phantom. Direction offlow is right to left. Only
minimal angulation off the beam axis relative to the
direction of flow is required to accurately display
the color flow profile. Narrow colorless area in the
Figure 11. Schematic shows the location of grat-
lumen of the vessel represents absence of Doppler
ing and side lobes of focused sound relative to the
shift where flow is perpendicular to the insonating
main beam.
beam. This is true reversal of flow relative to the
interrogating beam. Aliasing does not produce a
black area between color display of alternate color
direction (cf Fig 4a).

When a color Doppler image is produced (Fig 1 1). Side lobes occur in proximity to the
with a sector transducer, flow perpendicular primary beam. Grating lobes, however, can be
to the beam usually occurs over a small seg- quite far removed from the central beam (9).
ment of a vessel parallel to the transducer sur- The exact configuration of these lobes de-
face (Fig 10). With a linear transducer, this pends on the construction of the transducer,
becomes a more significant problem, but that is, crystal element size and spacing.
again, electronic beam steering or wedge Tightly curved, convex-array transducers are
standoffs can compensate. most susceptible, as are higher frequency lin-
ear transducers. If these off-axis lobes of
#{149}
Grating- or Side-Lobe Artifact sound strike a highly reflective surface, they
Electronically focused, phased-array transduc- can return to the transducer and cause mis-
ers concentrate the primary interrogating registration of an object on the display of the
beam toward the Doppler sample volume. primary beam. This artifact commonly con-
Because of the spacing of the array elements fuses needle biopsy guidance (10, 1 1).
and the sequence of firing, however, weak Off-axis lobes can interrogate vessels unre-
secondary lobes of focused sound may inter- lated to the Doppler sample volume. If a
rogate areas unrelated to the primary beam strong enough signal is encountered off axis,
it may appear on the spectral Doppler tracing,
displaying a Doppler shift where none is ex-
pected (Fig 12).

42 U RadioGraphic-s U Poznlak et a! Volume 12 Number 1

Figure 12. (a) Transverse image ofa Doppler phantom. Cursor is interrogating an area in the gelatin ma-
trix ofa Doppler phantom, far removed from the flow in the tube. A grating lobe, however, succeeds in inter-
rogating the vessel and displays Doppler shift on the spectral tracing. (b) In the longitudinal plane, the true
Doppler sample volume interrogates flow traveling toward the interrogating beam. The grating lobe, how-
ever, registers flow in the opposite direction as it interrogates an area completely separate from the primary
sample volume. (c) High-resistance tracing of the main renal artery in a transplant recipient. (d) This tracing
presumably represents a visceral artery interrogated by a side lobe. As the transducer is manipulated to ob-
tain a better tracing, a low-resistance flow pattern appears in the background (arrowheads); however, the
Doppler sample volume is squarely in the renal hilum. ART = artery, rn/s = meters per second.

#{149}
Spectral-broadening Artifact target traverses the sample volume, the Dop-
Spectral broadening is one of the characteris- pier angle varies. This introduces a slightly
tics identified in stenotic flow patterns. There- different Doppler frequency shift for each po-
fore, it is an important clinical sign. However, sition of the target and hence a broadened
spectral broadening may be introduced arti- spectrum.
factually and can cause errors in interpreting Spectral broadening is dependent on the
peak velocities in spectral waveforms. The angle of insonation (Fig 1 3) and the velocity
artifact occurs in pulsed and continuous-wave of the blood. Spectral broadening generally
Doppler because of the finite dimensions of becomes more severe for angles closer to 90#{176}.
the sample volume. A target traveling through Thus, errors can be minimized by using
the sample volume at a given speed intro- sound-beam orientation that results in a Dop-
duces a range of Doppler frequencies cen- pler angle of less than 60#{176}.
tered about the “true” Doppler frequency (ie,
the Doppler frequencyf0 calculated with the
equation mentioned previously) (12). As the

January 1992 Pozniak Ct a! U RadioGraphic-s U 43

 Figure 13. (a) Doppler spectral waveform for a flow phantom obtained with the Doppler beam angle at
71#{176}
relative to flow direction. (b) Waveform obtained with a Doppler angle of8l#{176}.Note broadening of the
spectral tracing, apparent increase in peak velocity, and partial filling of the systolic window for the steeper
(8 1#{176})
angle. VEL = velocity, rn/s = meters per second.

U CONCLUSIONS Trans Ultrasonics Ferroelectrics Frequency

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Most important, the display of flow informa- 4. Middleton WD, Melson GL. The carotid
tion from low-velocity states is dependent on ghost: a color Doppler ultrasound duplica-
sensitivity, transmit focal distance, velocity tion artifact. J Ultrasound Med 1990; 9:487-
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and spectral Doppler imaging. These controls 5. Kremkau 1W, Taylor KJW. Artifacts in ultra-
must be constantly fine-tuned relative to ye- sound imaging. J Ultrasound Med 1986;
5: 227-237.
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6. Reading CC, Charboneau JW, Allison JW,
tions are to be accurately demonstrated.
Cooperberg PL. Color and spectral Doppler
Operators must also be aware of distortions mirror-image artifact of the subclavian artery.
of flow information such as mirroring artifacts Radiology 1990; 174:41-42.
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9. ZagzebskiJ. Doppler instrumentation. In:
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Acknowledgment: We are grateful to Carrie sonic side.lobe artifacts. Radiology 1982; 145:
Poole for preparation of the manuscript. 763-768.
11 . Laing FC. Commonly encountered artifacts
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