In vitro validation of Doppler indices using blood and water

Using an in vitro flow model, volume flow and pressure were measured to compare calculated resistance with simultaneously measured continuous-wave Doppler indices during imposed changes in downstream resistance to pulsatile flow. With stepwise reductions in flow, the peak (S) and trough (D) points of the maximum shifted-frequency envelope fell in parallel in a linear fashion until D reached zero. Pressure remained constant, and the pressure waveform remained unchanged. As calculated resistance increased, resistance index (RI) and pulsatility index (PI) both increased in a linear fashion until the point at which D became zero. However, S/D ratio was not linear, and the slope increased as resistance increased. The results obtained from microspheres suspended in water and with heparinized sheep's blood were similar. The results indicate that, with reductions in flow at constant pressure in vitro, S/D ratio does not relate to calculated resistance in the same linear manner as PI and RI.