Ultrasonic colour flow imaging

Real-time ultrasonic colour flow imaging, which was first demonstrated to be feasible only about a decade ago, has come into widespread clinical use. Ultrasound is scattered by ensembles of red blood cells. The ultrasonic frequency that gives the best signal-to-noise ratio for backscattering from blood depends on the required penetration. The frequency of ultrasound backscattered from flowing blood is shifted by the Doppler effect. The direction of flow can be determined by phase quadrature detection, and range selectivity can be provided by pulse-echo time-delay measurements. The Doppler frequency spectrum can be determined by Fourier analysis. Early two- and three-dimensional flow-imaging systems used slow manual scanning; velocity colour coding was introduced. Real-time colour flow imaging first became feasible when autocorrelation detection was used to extract the Doppler signal. Time-domain processing, which is a broad-band technique, was also soon shown to be practicable, for analysing both radio-frequency pulse-echo wavetrains and two-dimensional image speckle. Frequency- and time-domain processing both require effective cancellation of stationary echoes. The time-domain approach seems to have advantages in relation to both aliasing and the effects of attenuation in overlying tissues. Colour-coding schemes that can be interpreted without the need to refer to keys have been adopted, for both velocity and flow disturbance. Colour coding according to signal power has also been reintroduced. Three-dimensional display has been demonstrated. In interpreting colour flow images, it is important to understand the functions of critical system controls and the origins of artifacts. Various strategies can be adopted to increase the image frame rate. The problems of performance measurement and safety need to be kept under review. There are numerous opportunities for further development of ultrasonic colour flow imaging, including improvements in system design, methods of image display, the use of contrast agents and the solution of previously unexplored clinical problems.