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.     

Three-dimensional reconstruction of fine vascularity in ultrasound breast imaging using contrast-enhanced spatial compounding: in vitro analyses

RATIONALE AND OBJECTIVES: Ultrasound image quality can be improved by imaging an object (here: the female breast) from different viewing angles in one image plane. With this technique, which is commonly referred to as spatial compounding, a more isotropic resolution is achieved while speckle noise and further artifacts are reduced. We present results obtained from a combination of spatial compounding with contrast-enhanced ultrasound imaging in three dimensions to reduce contrast specific artifacts (depth dependency, shadowing, speckle) and reconstruct vascular structures. MATERIALS AND METHODS: We used a conventional ultrasound scanner and a custom made mechanical system to rotate an ultrasound curved array probe around an object (360 degrees , 36 transducer positions). For 10 parallel image planes, ultrasound compound images were generated of a flow-mimicking phantom consecutively supplied with water and contrast agent. These compound images were combined to form a volume dataset and postprocessed to obtain a sonographic subtraction angiography. RESULTS: Image quality was significantly improved by spatial compounding for the native (ie, without contrast agent), and, in particular, for the contrast-enhanced case. After subtracting the native images from the contrast-enhanced ones, only structures supplied with contrast agent remain. This technique yields much better results for compound images than for conventional ultrasound images because speckle noise and an anisotropic resolution affect the latter. CONCLUSIONS: With the presented approach contrast specific artifacts can be eliminated efficiently, and a subtraction angiography can be computed. A speckle reduced three-dimensional reconstruction of submillimeter vessel structures was achieved for the first time. In the future, this technique can be applied in vivo to image the vascularity of cancer in the female breast.     

Compound spatial sonography of the thyroid gland: evaluation of freedom from artifacts and of nodule conspicuity

OBJECTIVE: The purpose of this study was to compare compound spatial sonography with conventional sonography of the thyroid gland with respect to freedom from sonographic artifacts and conspicuity of thyroid nodules. SUBJECTS AND METHODS: A prospective study was performed on 50 thyroid nodules (in 43 patients). Each nodule was examined using compound spatial sonography and conventional sonography. The sonographic techniques were then compared with respect to freedom from sonographic artifacts and thyroid nodule conspicuity. RESULTS: For freedom from artifacts, compound spatial sonography was superior in 45 cases (90%), and conventional sonography was superior in five cases (10%). Statistical analysis showed that compound spatial sonography was superior to conventional sonography for freedom from artifacts (p < 0.001). For thyroid nodule conspicuity, compound spatial sonography was superior in 37 cases (74%), and conventional sonography was superior in 13 cases (26%). Statistical analysis showed that compound spatial sonography was superior to conventional sonography for thyroid nodule conspicuity (p < 0.001). CONCLUSION: Compound spatial sonography of the thyroid displays greater freedom from artifacts and better nodule conspicuity than does conventional sonography.     

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.     

Hepatic sonography: comparison of tissue harmonic and standard sonography techniques.

OBJECTIVE: This study was performed to compare tissue harmonic sonography of the liver with conventional sonography of the liver. SUBJECTS AND METHODS: Forty-eight patients underwent tissue harmonic and conventional sonography of the liver, using a randomized imaging sequence. Imaging parameters were standardized, but gain varied. Techniques were compared using predetermined impact analysis categories. If a finding was revealed by only one sonographic technique, additional confirmation was obtained by another imaging technique or by surgery. In a separate image quality analysis, masked images were reviewed by two experienced radiologists to evaluate fluid-solid differentiation, near-field, far-field, and overall image quality. Rankings were correlated with field of view of images and body habitus of patients as determined by body mass index. RESULTS: Tissue harmonic sonography provided the same information as conventional sonography in 34 patients (71%) and added information in 14 patients (29%). The findings from tissue harmonic sonography resulted in altered treatment in five patients (10%). Eight patients (17%) had lesions revealed by tissue harmonic sonography only. Four patients (8%) had inadequate far-field visualization by both techniques. Both observers ranked tissue harmonic sonography the same as or better than standard sonography in 46 patients (96%) for fluid-solid differentiation, in 46 patients (96%) for near-field image quality, and in 45 patients (94%) for overall image quality. For far-field image quality, one observer ranked tissue harmonic sonography the same as or better than conventional sonography in 40 patients (83%), and the second observer, in 41 patients (85%). Image quality ratings showed no correlation with body habitus of the patients or field of view of images. CONCLUSION: Tissue harmonic sonography of the liver provides more information and better image quality than does conventional sonography of the liver.     

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.     

Real-time spatial compound sonography of Achilles tendon in patients with heterozygous familial hypercholesterolaemia and normal physical examination

PURPOSE: This study was undertaken to assess the prevalence and ultrasound features of Achilles tendon xanthomas (ATX) in patients with heterozygous familial hypercholesterolemia (HFH) and normal physical examination studied with high-resolution ultrasonography (HRUS) and, secondarily, to evaluate the role of real-time spatial compound sonography (CS) in terms of image quality. MATERIALS AND METHODS: Both Achilles tendons of 40 patients with HFH were studied with HRUS and CS. Two experienced radiologists evaluated by consensus the presence of ATX described as (1) tendon thickening and/or (2) focal hypoechoic areas and the quality of images obtained with the two techniques. RESULTS: Ten out of 80 tendons showed thickening (mean: 11.2 mm). Twelve xanthomas 4.1-9.8 mm were identified in 9/80 tendons of five patients. In 5/80 tendons, both tendon thickening and focal hypoechoic areas were observed. There was no difference in the number of xanthomas detected at conventional US or CS. With respect to image quality, the performance of CS was considered significantly higher than HRUS in 72/80 (90%) cases and equal to HRUS in the remaining 8/80 (10%) (p<0.001). CONCLUSIONS: CS is an effective tool in the assessment of ATX in patients with HFH and normal physical examination, and provides a better image quality when compared with HRUS.     

Application of adaptive image processing technique to real-time spatial compound ultrasound imaging improves image quality

RATIONALE AND OBJECTIVES: To assess the impact of adaptive filter postprocessing on quality of ultrasound images. METHODS: Ultrasound images acquired with real-time spatial compound imaging (SonoCT imaging) were subsequently processed with an adaptive real time algorithm (XRES imaging). Conventional and XRES-processed images from abdominal, pediatric or small parts ultrasound explorations were compared. The delineation of borders, tissue contrast, amount of noise, and overall image quality were evaluated. RESULTS: Delineation of borders and tissue contrast were improved on all images (P < 0.05). The amount of noise was reduced (P < 0.05). The overall image quality was improved for abdominal, pediatric and small parts ultrasound explorations (P < 0.05). No image degradation was found. CONCLUSIONS: Adaptive processing provided better image quality without loss of clinically useful information.     

Modern gray-scale sonography of the breast

Recently, the diagnosis of breast diseases by ultrasound has changed radically. It is no longer a complementary modality to mammography but a separate method to investigate breast disease. Innovative high-resolution ultrasound allows more specific diagnosis of breast tumors. Tissue-harmonic imaging not only uses the transmitted, fundamental frequency to obtain an image but also the harmonic frequency. The harmonic signal is processed by the ultrasound system with the result of better delineation of tissue structures and spatial compounding assembles an image from multiple images taken from different angles of echo waves. The effect is the reduction of artifacts with optimized contrast. Finally the advanced speckle reduction technique is used to smooth and homogenize the image. Additionally continuous advancement of new high-resolution linear transducers is responsible for the essential improvement of image quality. In conclusion, it is recommended to integrate all of the described modalities in order to obtain diagnostically conclusive image quality. This article demonstrates the new techniques and applications exemplified using images.     

Three-dimensional transrectal sonography of the bulbo-urethal glands

Three-dimensional transrectal sonography is a new imaging technique capable of providing sonographic sections in three planes simultaneously, which to date has not been possible by conventional techniques. Apart from the additional information obtained by the third, i. e. coronal, plane, this new technique permits precise three-dimensional analyses of relevant anatomical structures. In a total of 57 patients the bulbo-urethral glands were studied by means of three-dimensional transrectal sonography. In order to identify the visualized structures anatomically and topographically, the images obtained were compared with serial anatomical sections of several male pelves. The results show that, with the help of three-dimensional sonography, it is possible to obtain reproducible images by a routine procedure which enables the localisation and demonstration of the bulbo-urethral glands as well as the adjacent anatomical structures (organs, muscles, corpora cavernosa and vessels). Furthermore, a cyst in one of the bulbo-urethral glands could be definitively diagnosed and assessed in 3 patients. With the help of this non-invasive diagnostic tool it is now possible to assess the regions of the pelvic floor and prostate quickly, easily and with great precision. Any site which has been assessed in the volume scan can be simultaneously visualised in the three planes, which renders measurements in all three dimensions possible. Correspondence to: H. Strasser     

Gynecologic imaging: comparison of transabdominal and transvaginal sonography

The sonographic findings in 200 patients who underwent concurrent transabdominal and transvaginal pelvic ultrasound were reviewed. The sonographic techniques were compared for image quality, completeness of anatomic detail depicted, and unique diagnostic information. Transvaginal image quality was better in 79%-87% of scans; transabdominal image quality was better in 3%-5% of scans; images of both techniques were equally good in 10%-18% of scans. The techniques provided equivalent diagnostic information in 60%-84% of cases. Transvaginal sonography was particularly helpful when exclusion of ectopic pregnancy was the clinical concern. Individual organs and fine structures were better seen transvaginally, but the regional survey offered by the transabdominal full-bladder approach remains necessary to provide anatomic orientation, particularly when the patient has not been studied previously.     

Percutaneous ablation therapy guided by contrast-enhanced sonography for patients with hepatocellular carcinoma

OBJECTIVE: The newly developed contrast-enhanced harmonic gray-scale sonography technique enables us to improve the real-time detectability of viable tumor tissue in hepatocellular carcinoma lesions. We evaluated the usefulness of real-time percutaneous ablation therapy under guidance with this method for patients with hepatocellular carcinoma that is not depicted on conventional sonography. SUBJECTS AND METHODS: We examined 30 patients with 56 hepatocellular carcinomas using real-time contrast-enhanced harmonic gray-scale sonography after injection of a galactose-palmitic acid contrast agent and compared the results with the findings of contrast-enhanced helical CT. We performed percutaneous ablation therapy guided by this modality for treatment of viable hepatocellular carcinoma lesions that could not be detected using conventional sonography. RESULTS: High detection rates of viable hepatocellular carcinoma lesions were obtained using real-time contrast-enhanced harmonic gray-scale sonography (52/56 lesions, 93%); these rates were comparable to those of helical CT (54/56 lesions, 96%). Nine (90%) of the 10 lesions that were not detected on conventional sonography but were depicted on real-time contrast-enhanced harmonic gray-scale sonography (incomplete local treatment, n = 4; small new lesion, n = 6) were successfully treated with percutaneous ablation therapy guided by this method. CONCLUSION: Real-time contrast-enhanced harmonic gray-scale sonography improved the sensitivity for the detection of viable hepatocellular carcinoma lesions. Percutaneous ablation therapy guided by this modality may be useful in patients with hypervascular hepatocellular carcinoma lesions that cannot be detected using conventional sonography.     

The limitations of carotid sonography: interpretive and technology-related errors

OBJECTIVE: This study compared carotid artery sonography with angiography to determine, in retrospect, which types of sonographic errors arose from incorrect interpretation of sonographic images and which errors could be ascribed to the limitations of sonographic imaging. MATERIALS AND METHODS: A review of all patients who underwent carotid artery sonography and angiography between 1993 and 1997 at our institution revealed 66 patients with complete sets of studies, yielding 132 examinations (right or left). Studies were not reinterpreted and angiography was considered to be the gold standard. Only stenoses of 60% or greater were included in our study. If the degree or location of stenosis differed on the two imaging studies, they were reviewed together to classify the type of sonographic error. RESULTS: We found complete agreement of sonography and angiography in 115 cases (87%) and discrepancies in 17 (13%). Thirteen of 17 sonographic errors were false-positive interpretations and three were false-negative interpretations. One was an error in location. Retrospective review showed seven interpretive errors. In all these cases, the color Doppler image better revealed the degree of stenosis. Other complicating factors included inconsistencies between absolute velocities, velocity ratios, and waveforms obtained while a patient was being treated with an intraaortic balloon pump. In the other 10 discrepancies, the sonographic interpretation was accurate. Seven of these cases were false-positive interpretations in patients with contralateral occlusions or stenoses. The other three cases in this group showed long segments of stenosis, ulcerations, or tortuous vessels on angiography. CONCLUSION: Our study suggests that increased accuracy can be achieved in the interpretation of carotid artery sonography by meticulous attention to the color image. When color Doppler sonography is technically limited by tortuosity or ulceration, or if significant contralateral disease is present, misinterpretation is more likely.     

Carpal tunnel syndrome: diagnosis with high-resolution sonography.

OBJECTIVE. Carpal tunnel syndrome is characterized by typical anatomic changes that can be shown with high-resolution sonography. To determine whether these findings are reliable and can be used to establish the diagnosis, sonograms of patients with the disease were compared with sonograms obtained in patients with normal wrists. Also compared were sonograms and MR images obtained in the patients with carpal tunnel syndrome. SUBJECTS AND METHODS. Twenty wrists in 18 consecutive patients with clinical symptoms of carpal tunnel syndrome and with abnormal nerve conduction studies were examined with real-time sonography and MR imaging. The sonograms and MR images were evaluated quantitatively by two unbiased observers with regard to the size and shape of the median nerve and the palmar bowing of the flexor retinaculum. A t test was used to compare these data with those from previous sonographic studies of 28 normal wrists. Correlation coefficients for the measurements obtained with sonography and with MR were calculated. The relative accuracies of different diagnostic criteria for the diagnosis of carpal tunnel syndrome were assessed by using receiver-operating-characteristic analytical techniques. RESULTS. Characteristic findings on both MR and CT scans of the 20 wrists with carpal tunnel syndrome included swelling of the median nerve in the proximal part of the carpal tunnel in 16 wrists, flattening of the median nerve in the distal part of the carpal tunnel in 13 wrists, and increased palmar bowing of the flexor retinaculum in nine wrists. Comparison with the data of 28 normal wrists proved that these findings were significant (p less than .01 to p less than .001). Receiver-operating-characteristic analysis showed that the discrimination between wrists in normal subjects and in patients with carpal tunnel syndrome achieved with each of the three diagnostic criteria was not significantly different. Measurements of the size and flattening of the median nerve obtained from sonograms were similar to those on MR images, whereas sonography was less accurate for measuring the palmar bowing of the flexor retinaculum. CONCLUSION. We conclude that the results of sonography are reliable, and that the diagnosis of carpal tunnel syndrome can be established on the basis of sonographic findings.     

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.     

Tissue harmonic imaging sonography of breast lesions: Improved margin analysis, conspicuity, and image quality compared to conventional ultrasound

The purpose of this preference study is to determine if tissue harmonic imaging (THI) is preferred over conventional sonography for imaging breast masses. A prospective evaluation of 73 identical image pairs (one obtained with conventional sonography, one with THI sonography) was performed, examining 25 cysts, 36 solid masses, and 12 indeterminate lesions. Each image was evaluated for lesion contrast, margins, and overall image quality using a graduated score. Statistical analysis was performed using a modified t test. For cystic and solid lesions, THI was preferred for lesion conspicuity, margin, and overall quality (P<.001). For indeterminate lesions, THI was significantly preferred for lesion conspicuity and overall quality (P<.05), but the preference for margins was not significant. Overall, THI of breast lesions was significantly preferred for lesion contrast and margin evaluation compared to conventional sonography. This modality deserves further evaluation and may improve detection and evaluation of breast 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.     

Musculoskeletal sonography of the postoperative orthopedic patient

Musculoskeletal sonography has an important role in the evaluation of the postoperative orthopedic patient. One major advantage of sonography over magnetic resonance imaging and computed tomography is that artifact from metal, which is common after orthopedic surgery, is relatively limited. This allows a clear assessment of the soft tissues for abnormalities such as tendon tear, tenosynovitis, joint effusion, and soft tissue infection. Sonography also has a role in evaluation of recurrent soft tissue tumor, bone healing, and limb amputation. This article first discusses the basic technical aspects of musculoskeletal sonography and is followed by sonographic examples of normal anatomy. Common applications of musculoskeletal sonography in evaluation of the postoperative orthopedic patient are reviewed, including sonography after tendon surgery, assessment of soft tissues adjacent to orthopedic hardware, recurrent musculoskeletal soft tissue tumors, sonography of bone healing, and evaluation of limb amputation. Guidelines and pitfalls of these applications are reviewed.     

Hepatocellular carcinoma treated with radiofrequency ablation: comparison of pulse inversion contrast-enhanced harmonic sonography, contrast-enhanced power Doppler sonography, and helical CT.

OBJECTIVE: The purpose of this study was to compare the efficacy of contrast-enhanced pulse inversion harmonic imaging with contrast-enhanced power Doppler sonography and helical CT to determine incomplete local treatment after radiofrequency ablation in patients with hepatocellular carcinoma. MATERIALS AND METHODS: Thirty-five consecutive patients (24 men and 11 women; mean age, 64 years) with 43 hepatocellular carcinomas (3.6 +/- 1.1 cm) were treated using internally cooled radiofrequency ablation therapy. Therapeutic response was evaluated at 4 months with dual-phase contrast-enhanced helical CT, conventional power Doppler Sonography, and pulse inversion harmonic imaging using a sonographic contrast agent (SH-508). CT and sonographic studies were reviewed separately in random order by four radiologists at different consensus conferences. Sensitivity and specificity of the sonographic methods were determined using CT as a gold standard and results were compared using the McNemar test. RESULTS: CT examinations identified residual tumor in 12 lesions (27.9%). Although conventional contrast-enhanced power Doppler sonography identified residual viable tumor foci in four incompletely treated lesions (9.3%), contrast-enhanced pulse inversion harmonic imaging identified residual tumoral enhancement in 10 lesions (23.3%). Thus, the sensitivity of pulse inversion harmonic imaging (83.3%) was significantly greater (p < 0.05) for detecting residual nonablated tumor compared with conventional contrast-enhanced power Doppler sonography. CONCLUSION: Our study suggests that contrast-enhanced pulse inversion harmonic imaging may enable the detection of residual nonablated tumor in more cases than contrast-enhanced power Doppler sonography and may ultimately prove to be a useful adjunct for percutaneous ablation therapies. Nevertheless, contrast-enhanced axial imaging (CT or MR imaging) is currently the most sensitive test for managing thermal ablation for patients with hepatocellular carcinoma.     

Bladder leiomyoma: advantages of sonography over computed tomography

The complementary use of sonography in the evaluation of a bladder-base leiomyoma is reported. Sonography, as compared to computed tomography, was able to document the solid nature of the tumor, its submucosal location, and determined the site of origin and exact relationship to adjacent organs by virtue of the ability to image in multiple planes. The sonographic appearance of a submucosal, solid lobulated bladder-base mass is suggestive of a leiomyoma.