Ultrasound Artifacts: Seeing Beyond the Echoes

Abstract

Introduction: Ultrasound artifacts are frequently encountered during routine ultrasonography and may occur in B-mode grayscale, spectral Doppler, and color Doppler imaging. They may result from the physical properties of ultrasound propagation, tissue interfaces, equipment characteristics, or inappropriate imaging parameters. Although some artifacts may degrade image quality or mimic pathological findings, others provide useful diagnostic information. Recognition and appropriate correction of artifacts are therefore essential for accurate image interpretation and optimal patient care.
Patients and Methods: This observational study was conducted from January 2025 to January 2026 at the Institute of Nuclear Medicine and Allied Sciences, SSMCH, Mitford, Dhaka. A total of 1,567 patients undergoing ultrasonographic examinations were included. The examinations comprised transabdominal ultrasonography in 660 patients (42.1%), transvaginal ultrasonography in 650 patients (41.5%), and evaluation of superficial swellings in 257 patients (16.4%). Various artifacts encountered during B-mode ultrasonography were identified and categorized according to their underlying physical mechanisms. The most frequently observed artifact was posterior acoustic shadowing, identified in 450 patients (28.7%), followed by posterior acoustic enhancement in 230 (14.7%). Other artifacts included reverberation in 120 (7.7%), comet-tail artifact in 150 (9.6%), mirror-image artifact in 130 (8.3%), ring-down artifact in 134 (8.6%), beam-width artifact in 120 (7.7%), side-lobe artifact in 95 (6.1%), speckle artifact in 25 (1.6%), and electrical interference artifact in 113 (7.2%).
Conclusion: Ultrasound artifacts may produce diagnostic pitfalls by obscuring anatomical structures, degrading image quality, or
mimicking pathological abnormalities. A comprehensive understanding of the physical basis and imaging characteristics of artifacts
enables their recognition, appropriate correction, and, where applicable, diagnostic utilization. Familiarity with these phenomena is
essential for improving the accuracy and reliability of ultrasonographic interpretation and for reducing unnecessary additional
investigations.

BJusg. vol. 27, no. 1, June 2026, Page: 17-25