Comparison of conventional sonography, real-time compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography of abdominal and pelvic lesions

OBJECTIVE: The purpose of this study was to compare conventional sonography, real-time spatial compound sonography, tissue harmonic sonography, and tissue harmonic sonography merged with compound sonography for overall image quality, lesion conspicuity, and elimination of artifacts. SUBJECTS AND METHODS. In this study, 150 lesions in 122 randomly selected patients with various abdominal and pelvic lesions were evaluated. For each lesion, sonograms were obtained with four techniques: conventional sonography, real-time spatial compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography. All images were reviewed and graded independently by two observers for overall image quality, lesion conspicuity, and elimination of artifacts. RESULTS: Statistical analysis showed that for overall image quality, lesion conspicuity, and elimination of artifacts, tissue harmonic compound sonography was significantly superior to all of the other techniques; real-time spatial compound sonography was better than tissue harmonic sonography; and conventional sonography was the least valuable of all (p < 0.001). When data were analyzed separately according to lesion types, tissue harmonic compound sonography was significantly superior for revealing stone diseases, liver cysts, gallbladder polyps, and uterine myomas. For the remainder of lesion groups, spatial compounding was superior to tissue harmonic sonography for all aspects of evaluation, and conventional sonography was the least valuable (p < 0.05). CONCLUSION: In abdominal and pelvic scanning, tissue harmonic compound sonography provides the best overall image quality, best lesion conspicuity, and least artifacts of all the evaluated imaging modes. Spatial compound sonography is better than tissue harmonic sonography for the evaluation of lesions in general, despite some differences among lesion groups.     

Real-time compound sonography of the rotator-cuff: evaluation of artefact reduction and image definition

PURPOSE: The aim of this study was to compare real time compound sonography with conventional sonography in the evaluation of rotator cuff tears. MATERIALS AND METHODS: A prospective study was performed on 50 supraspinatus tendons in 101 patients treated by surgical acromioplasty. The surgeon described 33 (66%) full-thickness tears and 17 (34%) partial-thickness tears. All tendons were examined by conventional sonography and real time compound sonography on the day before surgery. The techniques were compared by evaluating the images for freedom from artefacts, contrast resolution and overall image definition. RESULTS: Real time compound sonography proved to be superior to conventional sonography as regards freedom from artefacts in 50 cases out of 50 (100%). It was superior to conventional sonography in evaluating the image contrast resolution in 45 cases out of 50 (90%), and superior to conventional sonography in overall image definition in 45 out of 50 cases (90%). CONCLUSIONS: Real-time compound sonography reduces the intrinsic artefacts of conventional sonography and allows better overall image definition. In particular, the digital technique allowed us to study the rotator cuff with better contrast resolution and sharper and more detailed images than did conventional sonography.     

Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material

AIM: To evaluate the effects of sonographic characteristics of thyroid nodules, the diameter of needle used for sampling, and sampling technique on obtaining sufficient cytological material (SCM). MATERIALS AND METHODS: We performed sonography-guided fine-needle biopsy (FNB) in 232 solid thyroid nodules. Size-, echogenicity, vascularity, and localization of all nodules were evaluated by Doppler sonography before the biopsy. Needles of size 20, 22, and 24 G were used for biopsy. The biopsy specimen was acquired using two different methods after localisation. In first method, the needle tip was advanced into the nodule in various positions using a to-and-fro motion whilst in the nodule, along with concurrent aspiration. In the second method, the needle was advanced vigorously using a to-and-fro motion within the nodule whilst being rotated on its axis (capillary-action technique). RESULTS: The mean nodule size was 2.1+/-1.3 cm (range 0.4-7.2 cm). SCM was acquired from 154 (66.4%) nodules by sonography-guided FNB. In 78 (33.6%) nodules, SCM could not be collected. There was no significant difference between nodules with different echogenicity and vascularity for SCM. Regarding the needle size, the lowest rate of SCM was obtained using 20 G needles (56.6%) and the highest rate of adequate material was obtained using 24 G needles (82.5%; p=0.001). The SCM rate was 76.9% with the capillary-action technique versus 49.4% with the aspiration technique (p<0.001). CONCLUSION: Selecting finer needles (24-25 G) for sonography-guided FNB of thyroid nodules and using the capillary-action technique decreased the rate of inadequate material in cytological examination.     

Gray-scale three-dimensional sonography of thyroid nodules: feasibility of the method and preliminary studies

The aim of the study was differential evaluation of new and classical sonographic features of benign thyroid nodules and thyroid cancer with three-dimensional gray-scale sonography and evaluation of the effectiveness of the thin-slice surface rendered images in comparison with multiplanar reformation (MPR) presentation. Fifty-four thyroid nodules were interactively evaluated with thin-slice smooth surface rendering: shape in the c-plane (parallel to the probe) and evaluation of echogenicity, margins and calcification/microcalcification-like echogenic foci in the a-plane (plane of the probe). Evaluation of the level of agreement in readers interpretation and between sonographic techniques was performed using the statistic. Surface rendering permitted visualization of the shape of the nodule in the c-plane in all cases, in contrast to only up to 48% of cases in MPR evaluation. Lobulated nodule shape in the c-plane was 82–100% sensitive and 47–53% specific in diagnosis of carcinoma. Surface rendered images showed more calcification/microcalcification-like echogenic foci than MPR ones. The level of agreement between the observers in the evaluation of features of thyroid nodules and the agreement between features of thyroid nodules on MPR and surface-rendered images showed at least moderate reproducibility (0.41). Three-dimensional thin-slice surface rendering sonography appears to be a feasible and effective method for thyroid nodule evaluation.     

Comparison of fundamental sonography, tissue-harmonic sonography, fundamental compound sonography, and tissue-harmonic compound sonography for focal hepatic lesions

Image qualities of fundamental, tissue-harmonic, fundamental compound, and tissue-harmonic compound sonography for evaluating focal hepatic lesions were compared. Two radiologists, blinded to the type of techniques and to the final diagnosis, independently evaluated 384 images of 96 hepatic lesions: hemangiomas (n=35), hepatic cystic lesions (n=28), cirrhosis-related nodules (n=22), focal nodular hyperplasia (n=1), and metastases (n=10). All images were graded in terms of lesion conspicuity, margin sharpness, and overall image quality using a 4- or 5-point scale. In the cases of cystic lesions, posterior acoustic enhancement and internal artifacts were also analyzed. A Friedman test was used for multiple statistical comparisons of the four techniques for all parameters. Compound imaging was significantly superior to fundamental imaging regarding lesion conspicuity, margin sharpness, and overall quality (P<0.05). For posterior enhancement and internal artifacts within the cyst, harmonic ultrasonography (US) was significantly better than fundamental US (P<0.05). For evaluating focal hepatic lesions on US, compound imaging provided better lesion conspicuity, better margin sharpness, and better overall image quality than fundamental imaging did. Tissue harmonic imaging also provided better posterior enhancement and fewer internal artifacts of the cyst than fundamental imaging.     

The benefits of comparing conventional sonography, real-time spatial compound sonography, tissue harmonic sonography, and tissue harmonic compound sonography of hepatic lesions

This study aimed to compare conventional sonography, tissue harmonic imaging (THI), spatial compound sonography (SONOCT), and SONOCT+THI for overall image quality, lesion conspicuity, and elimination of artifacts of hepatic lesions. Forty-five patients were randomly selected, and 51 different hepatic lesions were scanned using each of the four techniques. The combined images of SONOCT+THI exhibited the best image quality for solid and cystic lesions, while conventional images were the worst for most hepatic lesions (P<.001). SONOCT was the best for fatty liver.     

Incidentally discovered thyroid nodules: incidence, and greyscale and colour Doppler pattern in an adult population screened by real-time compound spatial sonography

PURPOSE: Our aim was to assess the incidence and ultrasound features of thyroid nodules in an adult population screened by means of high-resolution ultrasonography (HRUS) and to evaluate the contribution of real-time spatial compound sonography (CS) in terms of image quality. MATERIALS AND METHODS: A total of 704 consecutive patients (400 women, 304 men) without thyroid disease underwent HRUS and CS examination of the thyroid gland. Number, size, location, echotexture and colour Doppler pattern of detected nodules were assessed. Two radiologists also assessed image quality of the two techniques. RESULTS: Seven hundred and eleven thyroid nodules (size range 0.18-4.1 cm; mean: 1.1 cm) were detected in 233 subjects (33.1%). Of these, 416 (58.5%) were found in 143 women whereas 295 (41.5%) were detected in 90 men. In both genders, the number of detected nodules increased with age, with the highest prevalence in the seventh decade (p<0.001). There were 461/711 (64.9%) thyroid nodules that were hypoechoic, and 449/711 (63.1%) had peripheral vascularity only (p<0.001). Fine-needle aspiration (FNA) revealed no malignancies. CS was graded better than HRUS in 621/711 (87.3%) cases (p<0.001). CONCLUSIONS: The prevalence of benign, small, hypoechoic thyroid nodules with peripheral vascularity was high in our series, thus suggesting a conservative approach. CS provided better image quality compared with HRUS.     

Sonographic Evaluation of Breast Nodules: Comparison of Conventional, Real-Time Compound, and Pulse-Inversion Harmonic Images

Objective

To compare the use of conventional, real-time compound, and pulse-inversion harmonic imaging in the evaluation of breast nodules.

Materials and Methods

Fifty-two breast nodules were included in this study, conducted between May and December 2000, in which conventional, real-time compound, and pulse-inversion harmonic images were obtained in the same plane. Three radiologists, each blinded to the interpretations of the other two, evaluated the findings, characterizing the lesions and ranking the three techniques from grade 1, the worst, to grade 3, the best. Lesion conspicuity was assessed, and lesions were also characterized in terms of their margin, clarity of internal echotexture, and clarity of posterior echo pattern. The three techniques were compared using Friedman''s test, and interobserver agreement in image interpretation was assessed by means of the intraclass correlation coefficient.

Results

With regard to lesion conspicuity, margin, and internal echotexture of the nodules, real-time compound imaging was the best technique (p < 0.05); in terms of posterior echo pattern, the best was pulse-inversion harmonic imaging (p < 0.05). Real-time compound and pulse inversion harmonic imaging were better than conventional sonography in all evaluative aspects. Interobserver agreement was greater than moderate.

Conclusion

Real-time compound and pulse-inversion harmonic imaging procedures are superior to conventional sonography in terms of both lesion conspicuity and the further characterization of breast nodules. Real-time compound imaging is the best technique for evaluation of the margin and internal echotexture of nodules, while pulse-inversion harmonic imaging is very effective for the evaluation of the posterior echo patterns.     

Impact of sonography in gouty arthritis: comparison with conventional radiography, clinical examination, and laboratory findings

OBJECTIVE: To explore the typical sonographic features of gray-scale and Power Doppler of acute and chronic gouty arthritis in conjunction with radiographic, clinical, and laboratory findings. MATERIALS AND METHODS: All hand, finger, and toe joints of 19 patients with acute and chronic gout were examined with gray-scale and Power Doppler sonography. The number and size of bone changes detected with sonography was compared to radiographic findings. Vascularization of the synovial tissue was scored on Power Doppler (grades 0-3), and was compared with clinical appearance, including swelling, tenderness, and redness (grades 0-3). RESULTS: In acute gout, mild to moderate echogenic periarticular nodules with sonotransmission and hypervascularization of the edematous surrounding soft tissue were found. In chronic gout, tophaceous nodules completely blocked transmission of US wave, leading to strong reflexion and dorsal shadowing in a minority of cases. No significant difference in the detection of large bone changes (>2mm) was found between sonography and radiography. However, gray-scale sonography was significantly more sensitive in the detection of small bone changes (p<0.001). Power Doppler scores were statistically significantly higher than clinical examination scores (p<0.001). DISCUSSION: Sonography is superior to radiographs in evaluating small bone changes. The inflammatory process in joints can be better detected with Power Doppler sonography than with clinical examination. Typical sonographic appearance of acute and in particular of chronic gout might provide clues on gouty arthritis that adds to the information available from conventional radiography, clinical, and laboratory findings.     

甲状腺结节的高频超声声像图特点及彩色多普勒血流特征分析

目的 探究甲状腺结节的高频超声声像图特点结合彩色多普勒血流特征,从而鉴别判断甲状腺结节的良恶性.方法 以最终术后病理结果为依据,按良恶性病变的不同,将2017年1月～2018年5月接收的131例甲状腺结节患者分为甲状腺良性结节组和甲状腺恶性结节组两组.甲状腺良性结节组68例,甲状腺恶性结节组63例.均接受高频超声及彩色...     

Advantages of real-time spatial compound sonography of the musculoskeletal system versus conventional sonography

OBJECTIVE: Spatial compound sonography is a method that obtains sonographic information from several different angles of insonation and combines them to produce a single image. By reducing speckle and improving definition of tissue planes, this method can potentially improve image quality in musculoskeletal sonography. The purpose of our study was to compare real-time spatial compound sonography with conventional high-resolution musculoskeletal sonography. MATERIALS AND METHODS: Thirty-four patients underwent sonography of the musculoskeletal system for a variety of indications. All patients were evaluated using conventional high-resolution sonography and real-time spatial compound sonography performed with a 12-5-MHz multifrequency linear array transducer. Conventional images and compound images depicting the same musculoskeletal structure were obtained in pairs. A total of 118 images (59 image pairs) were randomly assorted and reviewed on a computer monitor by three experienced sonologists working independently. The reviewers were unaware of the type of images they were evaluating. Image quality was rated using a 5-point scale. The image parameters evaluated were definition of tissue planes, speckle, other noise, and image detail. RESULTS: Analysis of variance revealed that real-time spatial compound sonography significantly improved definition of soft-tissue planes, reduced speckle and other noise, and improved image detail when compared with conventional high-resolution sonography (p < 0.0001 for all evaluated parameters). CONCLUSION: Real-time spatial compound sonography significantly improved sonographic image quality in the musculoskeletal system when compared with conventional high-resolution sonography. Because musculoskeletal sonography is highly dependent on image quality and tissue-plane definition, spatial compound sonography represents an important development.     

超声显像下甲状腺结节内微钙化对乳头状癌的诊断价值

目的探讨超声显像下甲状腺结节内微钙化对乳头状癌的诊断价值。方法回顾性分析161例甲状腺结节患者超声检查与术后病理结果。结果乳头状癌组微钙化的发生率（88．5％）高于良性结节组（11．9％）,差异有统计学意义（P〈0．001）;超声检查中有微钙化组乳头状癌的发生率（78．0％）高于无微钙化组（5．9％）,差异有统计学意义（P〈0．001）,前者与后者相比发生乳头状癌的相对危险度（RelativeRisk,RR）为7．4,即超声显像发现有微钙化组患者获得乳头状癌的危险性是无微钙化组患者的7．4倍。结论超声显像下结节内微钙化是诊断甲状腺癌的良好指标。对超声检查发现甲状腺结节微钙化的患者,应高度警惕甲状腺癌可能。     

Phase-inversion sonography during the liver-specific late phase of contrast enhancement: improved detection of liver metastases

OBJECTIVE: The purpose of our study was to assess whether phase-inversion sonography during the late, liver-specific phase of contrast enhancement using Levovist improves the detection of hepatic metastases relative to unenhanced conventional B-mode sonography. SUBJECTS AND METHODS: Sixty-two patients were studied with unenhanced B-mode sonography and phase-inversion sonography 2.5 min after the injection of Levovist. All patients underwent one reference examination (CT, MR imaging, or intraoperative sonography). The conspicuity, number, size, and distribution of metastases before and after contrast administration as judged by a sonographer (who was unaware of other imaging findings) were compared with each other and with reference imaging. RESULTS: The conspicuity of metastases was improved by contrast-enhanced phase inversion in 94% of patients. Thirty-nine patients showed metastases on reference imaging; 36 of these were positive on baseline sonography and 38 on phase-inversion sonography. Phase-inversion sonography showed more reference imaging-confirmed metastases than baseline sonography in 28 patients (45%). The average number of confirmed metastases per patient was 3.06 for baseline sonography and 5.42 for contrast-enhanced phase-inversion sonography (p < 0.01). The average sensitivity for detecting individual metastases improved from 63% to 91%. Metastases of less than 1 cm were shown in 14 patients on baseline sonography, in 24 patients on phase-inversion sonography, and in 26 on reference imaging. Both sonographic techniques showed false-positive lesions in six patients. CONCLUSION: Contrast-enhanced phase-inversion sonography in the liver-specific phase of contrast enhancement using Levovist provides a marked improvement in the detection of hepatic metastases relative to unenhanced conventional sonography, without loss of specificity. Phase-inversion sonography was particularly advantageous in detecting small metastases and may be a competitive alternative to CT and MR imaging.     

New sonographic criteria for recommending fine-needle aspiration biopsy of nonpalpable solid nodules of the thyroid

OBJECTIVE: The purpose of our study was to provide new sonographic criteria for fine-needle aspiration biopsy of nonpalpable solid thyroid nodules. MATERIALS AND METHODS: Sonographic scans of 155 nonpalpable thyroid nodules in 132 patients were prospectively classified as having positive or negative findings. Sonographic findings that suggested malignancy included microcalcifications, an irregular or microlobulated margin, marked hypoechogenicity, and a shape that was more tall than it was wide. If even one of these sonographic features was present, the nodule was classified as positive (malignant). If a nodule had none of the features described, it was classified as negative (benign). The final diagnosis of a lesion as benign (n = 106) or malignant (n = 49) was confirmed by fine-needle aspiration biopsy and follow-up (>6 months) in 83 benign nodules, by fine-needle aspiration biopsy and surgery in 44 malignant and 15 benign lesions, and by surgery alone in five malignant and eight benign lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated on the basis of our proposed classification method. RESULTS: Of 82 lesions classified as positive, 46 were malignant. Of 73 lesions classified as negative, three were malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy based on our sonographic classification method were 93.8%, 66%, 56.1%, 95.9%, and 74.8%, respectively. CONCLUSION: Considering the high level of sensitivity of our proposed sonographic classification, fine-needle aspiration biopsy should be performed on thyroid nodules classified as positive, regardless of palpability.     

Positive predictive values of sonographic features of solid thyroid nodule

AimThe purpose of this study was to assess the positive predictive value of the suspicious sonographic features of solid nodules of the thyroid.Materials and methodsAfter approval by our institutional review board, we evaluated 594 sonographically detected nodules on which fine needle aspiration biopsy had been performed from January to December 2005. Among these, pure cystic lesions and inadequate pathologic results were excluded. The remaining 530 solid thyroid nodules were analyzed by two radiologists. Each lesion was classified based on four sonographic features that suggested malignancy: microcalcifications; an irregular or microlobulated margin; marked hypoechogenicity; and a shape that was taller than wide. The sensitivity, specificity, positive predictive value, and negative predictive value of the each sonographic feature were calculated.ResultsFinal pathologic results showed that 97 (18.3%) of 530 nodules were malignant. The positive predictive values for malignancy in each sonographic feature were microcalcifications, 38.6% (39/101); an irregular or microlobulated margin, 28.2% (70/248); marked hypoechogenecity, 49.4% (38/77); taller than wide shape, 59.8% (49/82). In terms of relative risk, microcalcification [P<.01, relative risk (RR)=3.115, 95% CI: 1.724–5.628], hypoechogenecity (P<.01, RR=2.510, 95% CI: 1.290–4.881). The shape of nodule which was taller than wide (P<.01, RR=7.624, 95% CI: 4.156–13.986) revealed the highest predictive sonographic finding suggesting malignancy. However, margin is the least significant feature of detection of thyroid malignancy (P=.27, RR=1.395, 95% CI: 0.777–2.505).ConclusionThe three sonographic features of solid thyroid nodule, that is, microcalcifications, marked hypoechogenecity, and a taller than wide shape are meaningful findings in the diagnosis of thyroid malignancy. The shape that was taller than wide was the most reliable sonographic feature for predicting malignancy.     

Size discrepancy between sonographic and pathological evaluation of solitary papillary thyroid carcinoma

Background

Sonographic size of suspicious thyroid lesions is an essential parameter in the evaluation of thyroid nodules, determining the need for needle biopsy and has impact on the extent of surgery. Limited data is available on the correlation between the size of the thyroid nodule on sonography and the actual size measured during histological examination. The aim of the present study was to compare these two modalities and to discuss the potential clinical implications of the findings in the study population.

Methods

The database of Rabin Medical Center was reviewed for all patients with histologically proven papillary carcinoma of the thyroid treated by thyroid surgery between 2005 and 2010.

Results

292 patients with papillary thyroid carcinoma were included. The mean sonographic size of the nodule was 2.19 ± 1.15 cm. The mean pathological diameter was 1.69 ± 1.09 cm. Discrepancies between tumor histological diameter and the sonographically measurement were more prominent in tumors larger than 1.5 cm. Nonetheless, 18.8% of thyroid nodules that were measured by US as larger than 1 cm, were found to be smaller than 1 cm on final pathology. Similarly, 7.2% of nodules evaluated by sonography were determined as being larger than 4 cm, while their definitive size was smaller than 4 cm.

Conclusions

We noted a significant discrepancy between the preoperative sonographic and the pathologic size measurements for papillary thyroid carcinoma. The sonographic evaluation misclassifies both patients with small and large thyroid tumors, and consequently exposes them to unnecessary workup and more extensive operation. This discrepancy between the ultrasound findings and actual tumor size should be taken into account in clinical practice and help guide the evaluation and treatment of patients with thyroid nodules.     

Sonography with intraarterial infusion of carbon dioxide microbubbles (sonographic angiography): value in differential diagnosis of hepatic tumors.

Differential diagnosis of small liver tumors is important, but is not always possible, even with angiography. To solve this problem, we introduced sonographic angiography, which combines sonography and angiography. The vascular pattern of a variety of hepatic nodules was evaluated with sonographic angiography, and the results were compared with those of conventional angiography. Sonographic angiography (sonography performed during intraarterial infusion of carbon dioxide microbubbles) was performed in 184 patients with a total of 222 hepatic nodules: 139 hepatocellular carcinomas, nine adenomatous hyperplasias, seven regenerative nodules, 21 hemangiomas, 33 metastases, seven lymphomas, one granuloma, and five focal nodular hyperplasias. Sonographic angiography detected a hypervascular pattern with peripheral blood supply in cases of hepatocellular carcinoma (sensitivity, 90%; specificity, 89%). Typical vascular patterns of adenomatous hyperplasia, hemangioma, metastasis, and focal nodular hyperplasia on sonographic angiography were hypovascularity (sensitivity, 100%; specificity, 91%), spotty pooling (sensitivity, 100%; specificity, 100%), peripheral hypervascularity (sensitivity, 64%; specificity, 100%), respectively. The detectability of hypervascularity was greater with sonographic angiography than with conventional angiography in hepatocellular carcinoma, metastasis, and hemangioma. Our experience indicates that sonographic angiography depicts characteristic vascular features that reflect the vascular anatomy of specific types of hepatic tumors, and thus is useful in the differential diagnosis of these lesions.     

Diagnostic accuracy of phase-inversion tissue harmonic imaging versus fundamental B-mode sonography in the evaluation of focal lesions of the kidney

OBJECTIVE: We compared phase-inversion tissue harmonic imaging with fundamental B-mode sonography in the evaluation of focal lesions of the kidney. SUBJECTS AND METHODS: For our prospective study, 114 patients underwent sonography of the kidneys in both modes, fundamental B-mode sonography and phase-inversion tissue harmonic imaging, in a randomly chosen scanning order. Imaging parameters were standardized. Sonographic diagnoses were made under real-time conditions by the examining radiologist. All sonographic diagnoses were compared with a diagnostic reference modality: contrast-enhanced CT, contrast-enhanced MR imaging, or histopathology. Three radiologists different from the examiners evaluated overall image quality, lesion conspicuity, and fluid-solid differentiation for both modalities using hard-copy images. RESULTS: In 70 patients, fundamental B-mode sonography as the first technique depicted 73 of 111 lesions 10 mm or larger and enabled 71 lesions to be correctly characterized (sensitivity, 65.8%; accuracy, 64.0%). As the first mode, phase-inversion tissue harmonic imaging depicted 57 of 65 focal lesions and enabled 54 lesions to be accurately classified in 44 patients (sensitivity, 87.7%; accuracy, 83.1%). The differences in sensitivity and accuracy were statistically significant (95% confidence interval). For overall image quality, lesion conspicuity, and fluid-solid differentiation phase-inversion harmonic imaging was superior to fundamental B-mode sonography (p < 0.0001). CONCLUSION: Phase-inversion tissue harmonic imaging is superior to fundamental B-mode sonography in the sonography of focal kidney lesions because phase-inversion tissue harmonic imaging has better overall image quality, lesion conspicuity, and fluid-solid differentiation. In six cases, phase-inversion tissue harmonic imaging added crucial diagnostic information that changed patient management.     

乳腺脂肪坏死的X线和超声诊断

目的探讨乳腺脂肪坏死的X线及B超表现，提高对本病影像诊断的认识。资料与方法回顾性分析25例经手术、病理证实的乳腺脂肪坏死X线平片及超声声像图表现。结果X线片表现：(1)双侧乳腺结构、密度不对称10例；(2)淡薄片影3例；(3)有毛刺的结节5例；(4)X线片无阳性发现5例。超声声像图表现：(1)16例(16／17，94．1％)非医源性脂肪坏死病灶位于皮下脂肪层；(2)结节回声高低不一(高、低、无)；(3)彩色Doppler超声病灶无血流信号8例。结论乳腺脂肪坏死根据其病因和时期，其影像表现多种多样。X线与B超检查结合，本组有65％可排除乳腺癌的诊断。位于乳腺脂肪层内的网状片影或有毛刺的结节首先考虑脂肪坏死的可能，紧密结合临床病史，可提高本病诊断准确性。     

Sonographic appearance of focal thyroiditis

OBJECTIVE: The purpose of this study is to report the sonographic appearance of focal thyroid nodules that prove to be lymphocytic thyroiditis on fine-needle aspiration. CONCLUSION: In a patient population undergoing sonography for palpable nodular disease without known thyroiditis, focal nodules of thyroiditis had a wide variety of appearances. They most commonly appeared as solid hyperechoic nodules with ill-defined margins. However, the echogenicity was variable, and calcification and cystic-appearing regions were also noted. The vascularity of these nodules as assessed with color Doppler and power Doppler sonography also varied widely. Biopsy of these lesions is still necessary because there are no sonographic features that can reliably diagnose these lesions as thyroiditis and differentiate them from other lesions.