The reverberation artifact occurs as a result of repetitive reflection back and forth between two highly reflective surfaces. In musculoskeletal ultrasound (MSKUS), it is most frequently encountered with needle guidance, metallic implants or pieces of glass. This artifact appears as equally spaced hyperechoic lines that blur the image. It is particularly important to recognize that this artifact makes the metallic structure appear thicker and deeper than it really is.
Artifacts in MSKUS refer to features in the scan that do not reliably represent the anatomic structure underneath the transducer. Knowledge of artifacts is critical for reliably interpreting images in MSKUS.
In the ultrasound scan below you can see an in-plane view of a needle with a reverberation artifact. The needle tip is identified by the position of the red arrow. The equally spaced hyperechoic artifact (yellow arrows) is beneath the actual needle.