Power-Doppler ultrasound (PD-US) imaging without contrast enhancement is being developed to routinely monitor for changes in blood perfusion. Although PD-US methods do not measure perfusion quantitatively, they can reliably indicate spatiotemporal variations in muscle perfusion once the clutter and noise power are sufficiently minimized. This paper explores a spatial registration method that is applied to echo signals prior to principal components analysis (PCA)-based clutter and noise filtering. The goal is to achieve PD-US images that predictably map relative perfusion. We use primarily echo-signal simulations to demonstrate sub-sample spatial registration of echo frames prior to clutter filtering over a range of tissue motion seen clinically. Registration narrows the eigen-spectrum of the tissue clutter component to a point where PCA filters are highly efficient at eliminating clutter power. However, the ability of the clutter filter to pass blood-signal power depends on the spatial patterns of blood cell movement in tissues. Prior in vivo studies have shown that symmetric Doppler spectra are most commonly observed for peripheral perfusion data. Symmetric spectra indicate nondirectional or diffuse perfusion patterns for which PD-US methods predictably pass 30-50% of the true blood-signal power. Given the unique features of peripheral perfusion imaging, spatial registration methods can significantly improve the reliability of PD-US imaging to represent tissue perfusion.
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