The diagnostic relevance of colour Doppler artefacts in carotid artery examinations

Purpose: Physical and technical artefacts of the colour Doppler method are examined with regard to their diagnostic relevance for the carotid artery. Materials and methods: After recording all diagnostic problems arising from physical and technical artefacts in 30,000 consecutively carotid arteries, the quantitative significance of relevant artefacts was determined in minor subgroups of the collective. Results: Acoustic shadowing causes diagnostic problems in morphological and haemodynamic evaluation of stenoses. Mirror image artefacts simulate flow in cases of actual vessel occlusion or mimic vessel wall ulceration in carotid plaques and stenoses. Insonation angle artefacts inhibit detection of flow or mimic flow reversal. Problems of spatial resolution lead to incorrect demonstration of the vessel lumen in stenotic findings. Aliasing, perivascular colour artefacts, and ghosting do not cause any diagnostic problems. Relevant shadowing artefacts occurred in 14.7%, and relevant mirror image artefacts in 2.5% of the pathological cases. Insonation angle artefacts occurred in 17.3% of the cases (when using standard apparatus setting). However, with an exact knowledge of the artefact phenomena, insonation angle artefacts could be eliminated and mirror image artefacts were recognized in all cases. Resolution artefacts resulted in underestimation of carotid stenoses by on average 13.3% of the degree of stenosis. Conclusion: In principle, four artefact phenomena give rise to diagnostic problems; however, with a good knowledge of the phenomena, only artefacts due to acoustic shadowing and limited spatial resolution are of diagnostic significance.