(TCD) Transcranial color Doppler sonography allows to evaluate the presence and flow direction of vessels as well as their relationships to surrounding structures.
A disadvantage of cerebrovascular ultrasonography is the attenuation of the ultrasound signal by the skull. The loss of power through the skull is considerable, the signal to noise ratio is poor and so contrast enhanced Doppler imaging is advantageous. The use of ultrasound contrast agents provides a diagnostic window of sufficient duration and imaging quality to improve an evaluation of the cerebral vessels. Contrast TCD also results in visualization of small arteries and veins and greater length of these vessels.

See also A-Mode, Cranial Bone Thermal Index, Transcranial Color Coded Sonography and Transcranial Window.

(TCCS) Transcranial color coded sonography is a combination of B-mode and pulsed wave Doppler. TCCS is used to study morphological and functional assessment of the circle of Willis, intracranial hemodynamics caused by extracranial artery stenosis, collateral flow and the vascular supply of intracranial lesion. Color imaging of the intracranial vessels allows placing the spectral Doppler volume correctly. This modality has encouraged the widespread use.
Contrast enhanced TCCS analysis of cerebral arteriovenous transit time (cTT) is used as a measure of cerebral microcirculation.
The windows that are used for transcranial Doppler examinations include regions where the skull bones are relatively thin or where naturally occurring gaps allow proper penetration of the sound beam.

See also A-Mode, Cranial Bone Thermal Index, Transcranial Doppler and Transcranial Window.

Cerebrovascular ultrasonography is the best screening tool for the detection of carotid artery stenosis. Transcranial sonography is used in the evaluation of patients with suspected cerebrovascular disease, but a common problem is the attenuation of the ultrasound signal by the skull.
Contrast enhanced ultrasound play a particularly important role in the visualization of the intracranial vessels, and thus improves the accuracy of transcranial Doppler and increases the potential of this technique. The use of microbubbles is helpful for classification of stenosis and for plaque evaluation in patients with poor initial examination. Ultrasound contrast agents avoid misdiagnosing a subtotal stenosis, which is a very important clinical issue.

See also Adventitia, Intima, Periorbital Doppler, and Acoustic Window.

Contrast agents improve the sensitivity of vascular Doppler ultrasound, for example in cerebrovascular sonography or examinations of deep abdominal vessels. They also enlarge the role of transcranial Doppler. Microbubbles can be used with various modes e.g., color and power Doppler imaging, as well as pulsed-wave Doppler to increase the signal intensity. However, the ultrasound system must be suitable for contrast enhanced technology.
Microbubbles usually stay within the vascular space; nevertheless, the contrast enhancement is limited to 2−6 minutes caused by physiologic clearance and bubble destruction.
Depended on the application, contrast agents can be administered with a different injection rate e.g., bolus injection, slow injection, or continuous infusion. Stable, homogeneous, and prolonged enhancement can be obtained with perfusion, lasting until the infusion is stopped.

See also Cerebrovascular Ultrasonography, Multiple Frame Trigger.

Doppler ultrasound is a medical imaging technique for calculating the relative velocity between two points by measuring the frequency shift of a sound wave transmitted from one point to the other, based on the Doppler effect. Continuous or pulsed Doppler is frequently used to examine cardiovascular blood flow. The combination of routine 2D-mode and Doppler ultrasound allows a complete evaluation of the heart's anatomy and function (including the fetal heart). See also Doppler Fluximetry in Pregnancy.
Doppler ultrasound depends on the fact that if a moving object reflects the ultrasound waves, the echo frequencies are changed. A higher frequency is created if the object is moving toward the probe//transducer and a lower frequency if it is moving away from it. How much the frequency is changed depends upon how fast the object is moving. Doppler ultrasound shows the different rates of blood flow in different colors on a monitor in real time.
The major Doppler parameters are the peak systolic velocity and the end-diastolic velocity. The peak systolic velocity ratio compensates the variability between different patients and instrumentations.

Different Doppler and duplex techniques: