美國超聲心動圖學會（ASE）成立於1975年，是世界上最大的心臟影像國際組織。本文節選轉載美國超聲心動圖學會的《成人經胸超聲心動圖操作指南》有關頻譜都卜勒成像測量方面的內容。
頻譜都卜勒成像測量
(SPECTRAL DOPPLER IMAGING MEASUREMENTS)
D.左心室流出道和主動脈瓣( LVOT and AV)
The LVOT is best evaluated in the apical five-chamber or apical longaxis views. PW Doppler is used to obtain velocity in the LVOT. The PW Doppler sample volume is placed about 5 mm proximal to the AV in the center of the LVOT. The spectral signal should be narrow, with a rapid upstroke and an end-systolic click terminating the flow signal. Broadening of the flow signal indicates that the sample volume is too close to the AV and should be repositioned. The peak velocity should be measured and the signal traced to calculate a VTI (Table 6.10a).
LVOT最好在心尖五腔或心尖長軸切面中評估。PW都卜勒用於LVOT中探查速度。PW都卜勒採樣體積被置於LVOT中心靠近AV約5mm位置處。頻譜信號應該是狹窄並快速上行，血流信號終止於收縮末期關閉音。血流信號變寬表明取樣容積太接近AV，應該重新定位。測量峰值速度並追蹤信號以計算速度-時間積分（表6.10a）。
6.10.a. 心尖聲窗 A5C
進行測量：LVOT的頻譜都卜勒 1. LVOT血流速度時間積分 2. LVOT峰值流速
If high velocities or turbulent flow is present,CDI of the LVOTand left ventricle should be examined. Further abnormality (i.e., presence of AV stenosis) should prompt pulsed-Doppler mapping from the LV apex to the AV, noting the level at which high velocities are detected. If aliasing is present, a switch to HPRF Doppler can be considered to further evaluate flow velocities and the shape of the flow signal (Table 6.10b).
如果存在高速血流或湍流，應檢查LVOT和LV的CDI。進一步的異常（例如存在AV狹窄）應該使用脈衝都卜勒從LV心尖到AV掃查，注意檢測到高速血流的位置。如果出現混疊，可以考慮切換到HPRF都卜勒以進一步評估流速和流量信號的形狀（表6.10b）。
6.10.b. 心尖聲窗 A5C
進行測量：LVOT高脈衝重複頻率都卜勒 1. LVOT峰值流速
After sampling the LVOT, CW Doppler is used to measure the aortic velocity. The Doppler signal should be traced to provide a peak velocity, peak gradient, mean gradient, and VTI. The distinct flow signal border should be traced, and weak, shaggy, low-amplitude clutter should not be included in the VTI tracing (Table6.11).
在採樣LVOT後，CW都卜勒用於測量主動脈血流速度。應描記都卜勒信號以提供峰值速度，峰值壓力梯度，平均壓差和速度-時間積分。應該描記不同的血流信號邊界，並且VTI描記中不應包含微弱，粗糙，低幅度的雜波（表6.11）。
6.11. 心尖聲窗 A5C
進行測量：
心尖聲窗定向通過主動脈瓣的連續都卜勒頻譜 1. 主動脈瓣連續都卜勒頻譜 2. 主動脈瓣峰值速度
If aortic stenosis is suspected,a prosthetic valve is present,or high-velocity lesions are suspected in the LVOT, the nonimaging transducer should be used to acquire Doppler signals from the apical, right parasternal, and SSN windows.In difficult patients,to assist with placement of the nonimaging CW Doppler transducer, a duplex imaging transducer should be used first and its position noted. If aortic regurgitation is present, CW Doppler should be used to measure the peak velocity and pressure half-time. Color Doppler is used to direct the CW interrogation,as the regurgitant jet is frequently eccentric (Table 6.12).
如果懷疑存在主動脈瓣狹窄（AS），或者存在人工瓣膜或LVOT中存在高速病變，則應使用非成像探頭從心尖，右側胸骨旁（RPS）和SSN窗獲取都卜勒信號。對於困難的患者，應首先利用雙向成像傳感器確定位置，以輔助非成像CW都卜勒探頭定位。 如果存在主動脈瓣返流，應使用CW都卜勒測量峰值流速和壓力減半時間。彩色都卜勒用於指導CW探查，因為返流束經常是偏心的（表6.12）。
6.12. 心尖聲窗 A5C
進行測量：
連續都卜勒 1. 主動脈瓣反流峰值速度 （用於PISA法定量反流量）
2. 主動脈瓣反流斜率（用於計算壓差減半時間）
E.主動脈弓和降主動脈( Aortic Arch and Desc Ao)
CW Doppler may be used to evaluate the Desc Ao for the presence of flow-limiting obstructions. PW Doppler can be used to sample multiple positions in the Asc Ao, transverse aortic arch, and Desc Ao (Tables6.13a，6.13b).
CW 都卜勒可用於評估降主動脈是否存在限流障礙物。PW 都卜勒可用於升主動脈，主動脈弓和降主動脈中多個位置取樣（表6.13a，b）。
6.13a. 胸骨上窩聲窗
進行測量：升主動脈的脈衝都卜勒頻譜 1. 收縮期峰值流速
6.13b. 胸骨上窩聲窗
進行測量：
降主動脈的脈衝都卜勒頻譜 1. 收縮期峰值速度
This is done to evaluate any aortic pathology and to better define the location of obstructive lesions, such as coarctation of the aorta.Color Doppler can be used to guide the placement of the sample volume in interrogation of obstructive lesions. PW Doppler evaluation of the proximal Desc Ao can also be used to evaluate for diastolic reversal of flow associated with aortic regurgitation, rupture of the SoVAo, noncompliant aorta in elderly patients, arteriovenous fistula in the upper extremity, and aortic dissection (Table 6.14). Routine flow sampling should be performed in the proximal Desc Ao 10 mm below the origin of the left subclavian artery using a 3- to 5-mm sample volume. The normal PW Doppler signal is systolic and nonturbulent. In normal individuals, there typically is a brief low-velocity, early diastolic flow reversal. Reversal velocities longer than the first third of diastole are abnormal and associated with aortic regurgitation (Table 6.14).
由此評估任何主動脈病變，並更好地確定阻塞性病變的位置，如主動脈縮窄。彩色都卜勒在探查阻塞性病變時可用於指導取樣容積的位置。脈衝都卜勒對降主動脈近端的測定也可用於評估與AR血流相關的舒張期返流，SoVAo破裂，老年患者主動脈不順應性，上肢動靜脈瘻和主動脈夾層（表6.14）常規血流取樣容積應使用3-5mm的樣本量，在左鎖骨下動脈起點以下10mm處進行。正常的PW都卜勒信號是收縮期血流和非湍流。在正常人中，通常存在短暫的早期低速舒張流逆轉。反流速度超過舒張期的三分之一為異常並且與AR有關（表6.14）。
6.14.胸骨上窩聲窗
進行測量：主動脈瓣反流患者的降主動脈脈衝都卜勒頻譜顯示舒張期逆流
1.主動脈瓣反流的血流速度時間積分
F.肝靜脈(Hvns)
Hvn flow is a three-component signal consisting of the S wave of flow into the IVC during systole, the D wave of flow into the IVC during the first part of diastole, and the A wave of flow reversal in the Hvn caused by atrial contraction.Some patients have a fourth component: a brief ventricular flow reversal wave immediately following the Swave.A samplevolume of 3 to 5 mm is placed in the Hvn about 1 to 2 cm from the junction with the IVC. Flow is recorded at this site and should be assessed during an entire respiratory cycle. Although absolute peak velocity measurements are not routinely recorded, the pattern of flow is a valuable diagnostic tool. If performed,peak S- and D-wave velocities should be measured at endexpiration (Table 6.15).
肝靜脈血流是三相波，包括在收縮期流入IVC的S波，在舒張早期流入IVC的D波和由於心房收縮導致肝靜脈反流的A波。一些患者有第四種相：在S波後立即發生短暫的心室返流波。將3-5毫米的取樣容積放置在離下腔靜脈內交界處約1-2釐米的肝靜脈中。在此處記錄流速，同時應在整個呼吸周期內進行評估。雖然絕對峰值速度測量不是常規記錄，但血流模式是一種有價值的診斷工具。如果測量的話，應在呼氣末時測量S波和D波峰值速度（表6.15）。
6.15. 劍突下聲窗
進行測量： 肝靜脈血流的脈衝都卜勒頻譜 1. S波 2. D波 3. A波
G.肺靜脈( Pulvns)
Inflow from the Pulvns to the left atrium is best imaged from the A4C or apical five-chamber view. Typically, the right upper Pulvn, or at times the right lower Pulvn, has flow almost parallel to the Doppler cursor. A 3- to 5-mm sample volume should be placed about 10 mm proximal to the vein’s junction with the left atrium. Color Doppler aids in the positioning of the sample volume. 3 The flow signal is typically triphasic, with an S wave (during ventricular systole), D wave (during early diastole), and A reversal wave (during atrial contraction). The inflow should be recorded in all patients (Table 6.16).The pattern of the inflow signal is important in several diagnostic settings. Actual peak velocity measurements of each wave are not part of a routine examination but may be measured and the duration of the A wave measured for comparison with the MV A-wave duration in some circumstances.
從肺靜脈流入左房血流最好從心尖四腔或五腔切面觀察。 通常，右上肺靜脈或有時右下肺靜脈幾乎平行於都卜勒聲束。一個3-5毫米的取樣容積應放置在肺靜脈與LA交界處近10毫米處。彩色都卜勒有助於取樣容積的定位。 血流信號通常是三相的，包含S波（心室收縮期），D波（舒張早期）和反流A波（心房收縮期）。應該記錄患者的所有流入情況（表6.16）。 流入信號的模式在一些診斷情況下很重要。每個波的實際峰值速度測量不是常規檢查的一部分，但可以測量A波的持續時間，以便與某些情況下的二尖瓣A波持續時間進行比較。
6.16. 心尖聲窗 A4C切面
進行測量：
肺靜脈血流 1. S波 2. D波 3. A波
H.二尖瓣和三尖瓣瓣環的組織都卜勒
Tissue Doppler of the Mitral and Tricuspid Annuli
Tissue Doppler is used to record velocities of the longitudinal movement of the lateral and medial mitral annulus as well as the lateral tricuspid annulus.The angle of interrogation should be as parallel as possible to the Doppler beam. DTI presets are markedly different from conventional PW Doppler settings and vary by manufacturer. It is best to have a system-specific preset for these measures. Tissue Doppler signals should be optimized by using a large sample volume of 5 to 10 mm to fully capture annular motion, and the scale should be set at ≤25 cm/sec depending on the actual velocity. To improve visualization of the peak annular velocities, decrease the velocity scale to maximize Doppler signal display and set the sweep speed at 100 mm/sec. Velocity waveforms are designated as s' for systole, e' for early diastole, and a' for atrial contraction. Accurate measurement is important, as both absolute velocities and the ratio of mitral E velocity to e' velocity are major parts of diagnostic criteria for noninvasive estimation of LV filling pressure and diastolic performance. Provision should be made to average the peak lateral and medial velocities of all three components and to report these values. The averaged e' is used for calculation of the E/e' ratio in addition to individual data from the lateral and medial sites. Similar protocols are used for the lateral tricuspid annulus. The most important measurement for the right heart is the s' velocity, which correlates well with alternative measures of global RV systolic function (Table 6.17).
組織都卜勒用於記錄二尖瓣環外側和內側、三尖瓣環外側的縱向運動速度。 掃查角度應儘可能平行於都卜勒聲束。TDI預設與傳統的PW都卜勒設置明顯不同，並且因製造商而異。最好有一個系統特定的預設。應該通過採用5-10mm的大取樣容積來充分顯示瓣環運動以優化組織都卜勒信號，並且根據實際速度，標度應該設置在25cm/s或更低。 為了改善瓣環峰值速度的可視化，減低速度標度以最大化都卜勒信號顯示並將掃描速度設置為100mm/s。速度波形被指定為收縮期的s'，舒張早期的e'和心房收縮的a'。準確的測量非常重要，因為絕對速度和二尖瓣E速度與e'速度的比值是無創評估LV充盈壓和舒張功能診斷標準的重要組成部分。取三組外側和內側峰值速度的平均速度作為報告值。除了來自外側和內側部位的單個數據之外，e'平均值被用於計算E/e'比率。同樣的標準也適用於三尖瓣側壁瓣環。對於右心的最重要的測量是s'速度，它與整體RV收縮功能的相關性良好，可作為RV整體收縮功能的替代評估指標（表6.17）。
6.17. 心尖聲窗 A4C切面
進行測量：二尖瓣側壁瓣環組織都卜勒 1. s『 2. e『 3. a『