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Linear equations for modeling echo signals from shift-variant systems forming ultrasonic B-mode, Doppler, and strain images are analyzed and extended. The approach is based on a solution to the homogeneous wave equation for random inhomogeneous media. When the system is shift-variant, the spatial sensitivity function-defined as a spatial weighting function that determines the scattering volume for a fixed point of time-has advantages over the point-spread function traditionally used to analyze ultrasound systems. Spatial sensitivity functions are necessary for determining statistical moments in the context of rigorous image quality assessment, and they are time-reversed copies of point-spread functions for shift variant systems. A criterion is proposed to assess the validity of a local shift-invariance assumption. The analysis reveals realistic situations in which in-phase signals are correlated to the corresponding quadrature signals, which has strong implications for assessing lesion detectability. Also revealed is an opportunity to enhance near- and far-field spatial resolution by matched filtering unfocused beams. The analysis connects several well-known approaches to modeling ultrasonic echo signals.