In ultrasonography, a signal generator is combined with a transducer. Piezoelectric crystals in the signal generator convert electricity into high-frequency sound waves, which are sent into tissues. The tissues scatter, reflect, and absorb the sound waves to various degrees. The sound waves that are reflected back (echoes) are converted into electric signals. A computer analyzes the signals and displays the information on a screen.

Ultrasonography is portable, widely available, and safe. No radiation is used.

Variations

Ultrasound information can be displayed in several ways.

A-mode: This display mode is the simplest; signals are recorded as spikes on a graph. The vertical (Y) axis of the display shows the echo amplitude, and the horizontal (X) axis shows depth or distance into the patient. This type of ultrasonography is used for ophthalmologic scanning.

B-mode (gray-scale): This mode is most often used in diagnostic imaging; signals are displayed as a 2-dimensional anatomic image. B-mode is commonly used to evaluate the developing fetus and to evaluate organs, including the liver, spleen, kidneys, thyroid gland, testes, breasts, and prostate gland. B-mode ultrasonography is fast enough to show real-time motion, such as the motion of the beating heart or pulsating blood vessels. Real-time imaging provides anatomic and functional information.

M-mode: This mode is used to image moving structures; signals reflected by the moving structures are converted into waves that are displayed continuously across a vertical axis. M-mode is used primarily for assessment of fetal heartbeat and in cardiac imaging, most notably to evaluate valvular disorders.

Doppler: This type of ultrasonography is used to assess blood flow. Doppler ultrasonography uses the Doppler effect (alteration of sound frequency by reflection off a moving object). The moving objects are RBCs in blood.

Direction and velocity of blood flow can be determined by analyzing changes in the frequency of sound waves:

• If a reflected sound wave is lower in frequency than the transmitted sound wave, blood flow is away from the transducer.
• If a reflected sound wave is higher in frequency than the transmitted sound wave, blood flow is toward the transducer.
• The magnitude of the change in frequency is proportional to blood flow velocity.

Changes in frequency of the reflected sound waves are converted into images showing blood flow direction and velocity.

Color Doppler Ultrasonography of Wrist Tendons

Duplex Doppler ultrasonography combines the graphic display of spectral ultrasonography with the images of B-mode. For color Doppler ultrasonography, color is superimposed on a gray-scale anatomic image. The color indicates direction of blood flow. By convention, red indicates flow toward and blue indicates flow away from the transducer.

Doppler ultrasonography is also used to evaluate vascularity of tumors and organs, to evaluate heart function (eg, as for echocardiography), to detect occlusion and stenosis of blood vessels, and to detect blood clots in blood vessels (eg, in deep venous thrombosis).

Disadvantages

Quality of images depends on the skills of the operator. Obtaining clear images of the target structures can be technically difficult in overweight patients.

Ultrasonography cannot be used to image through bone or gas, so certain images may be difficult to obtain.

Last full review/revision July 2008 by Jon A. Jacobson, MD

Content last modified October 2010