Pulse Volume Recording (PVR) is NOT an Ultrasound
Pulse Volume Recording (PVR) is a physiological plethysmography test that measures limb volume changes with each pulse, not an ultrasound imaging technique. 1
What PVR Actually Is
PVR is a plethysmography-based physiological test that works by:
- Inflating pneumatic cuffs at predetermined levels on each limb 1
- Detecting minuscule volume changes in the limb with each cardiac pulse 1
- Creating waveform tracings that reflect arterial blood flow quality 1
- Providing qualitative assessment of limb perfusion without direct vessel imaging 2
The American College of Radiology clarifies that plethysmography detects changes in limb volume by PVR, distinguishing it from imaging modalities 2
Key Distinction from Ultrasound
Physiological testing versus imaging: The American College of Cardiology defines physiological testing as "evaluation of the peripheral circulation based on measurement of limb blood pressures with pulse volume recordings or Doppler waveforms, or other parameters without utilizing data from direct imaging of the blood vessels" 2
This is fundamentally different from:
- Duplex ultrasound, which combines grayscale 2D imaging, color Doppler, and spectral waveform analysis to directly visualize vessel anatomy 3
- US Duplex Doppler, which provides direct anatomic imaging of blood vessels 2
Clinical Context
PVR is used complementarily with other tests:
- The American College of Cardiology recommends PVR as reasonable for establishing initial PAD diagnosis, assessing localization and severity, and following revascularization procedures 2
- PVR is particularly valuable in patients with noncompressible vessels (diabetes, chronic kidney disease) where ankle-brachial index fails because it relies on volume change rather than pressure 1, 3
- However, PVR has fallen out of favor over time due to lack of reliable and reproducible quantitative data 2
Common Pitfall
Do not confuse PVR waveforms with Doppler ultrasound waveforms—while both create tracings, PVR measures volume changes through plethysmography cuffs, whereas Doppler ultrasound directly measures blood flow velocity using sound waves 2, 3