Tissue harmonic imaging, frequency compound imaging, and conventional imaging: use and benefit in breast sonography.

OBJECTIVE: The purpose of this study was to evaluate different sonographic settings (tissue harmonic, frequency compounding, and conventional imaging) and to determine which setting optimizes breast lesion detection and lesion characterization. METHODS: Four hundred thirteen consecutive breast lesions (249 benign and 164 malignant) were evaluated by sonography using 4 different modes (conventional imaging at 14 MHz, tissue harmonic imaging at 14 MHz [THI], and frequency compound imaging at 10 MHz [CI10] and 14 MHz [CI14]). The images were reviewed by consensus by 2 breast radiologists. For each image, the lesion was graded for conspicuity, mass margin assessment, echo texture assessment, overall image quality, and posterior acoustic features. RESULTS: For lesion conspicuity, THI and CI14 were better than conventional imaging (P < .01) and CI10 (P < .01) particularly against a fatty background (P < .01 for THI versus conventional for a fatty background versus P = .13 for a dense background). Frequency compound imaging at 10 MHz performed the best in echo texture assessment (P < .01), as well as overall image quality (P < .01). For margin assessment, CI10 performed better for deep and large (> or =1.5-cm) lesions, whereas CI14 performed better for small (<1.5-cm) and superficial lesions. Finally, THI and CI14 increased posterior shadowing (P < .01) and posterior enhancement (P < .01). CONCLUSIONS: The standard breast examination incorporates 2 distinct processes, lesion detection and lesion characterization. With respect to detection, THI is useful, especially in fatty breasts. With respect to characterization, compound imaging improves lesion echo texture assessment. No single setting in isolation can provide the necessary optimized information for both of these tasks. As such, a combination approach is best.     

Tissue harmonic imaging: utility in breast sonography.

OBJECTIVE: To determine the impact of tissue harmonic imaging on visualization of focal breast lesions and to compare gray scale contrast between focal breast lesions and fatty tissue of the breast between tissue harmonic imaging and fundamental frequency sonography. METHODS: A prospective study was performed on 219 female patients (254 lesions) undergoing sonographically guided fine-needle biopsy. The fundamental frequency and tissue harmonic images of all lesions were obtained on a scanner with a wideband 7.5-MHz linear probe. Twenty-three breast carcinomas, 6 suspect lesions, 9 fibroadenomas, 1 papilloma, 1 phyllodes tumor, 162 unspecified solid benign lesions, and 40 cysts were found. In 12 cases the fine-needle aspiration did not yield sufficient material. The gray scale intensity of the lesions and adjacent fatty tissue was measured with graphics software, and the gray scale contrast between lesions and adjacent fatty tissue was calculated. RESULTS: Tissue harmonic imaging improved the gray scale contrast between the fatty tissue and breast lesions in 230 lesions (90.6%; P < .001) compared with fundamental frequency images. The contrast improvement was bigger in breasts with predominantly fatty or mixed (fatty/glandular) composition than in predominantly glandular breasts. The overall conspicuity, lesion border definition, lesion content definition, and acoustic shadow conspicuity were improved or equal in the harmonic mode for all lesions.CONCLUSIONS: The tissue harmonic imaging technique used as an adjunct to conventional breast sonography may improve lesion detectability and characterization.     

Reduction of stent artifacts using high-frequency harmonic ultrasound imaging

Tissue harmonic imaging (THI) has been shown to improve medical ultrasound (US) image quality in the frequency range from 2 to 10 MHz and might, therefore, also be advantageous in high-frequency US applications, like US biomicroscopy and intravascular US (IVUS). In this study, we compared high-frequency THI (40 MHz) with fundamental imaging (20 and 40 MHz) with a distorting reflective metal stent in the near fields of both a spherically-focused US biomicroscopy transducer (aperture 8 mm, focal distance 13 mm) and an unfocused elliptical IVUS element. Hydrophone measurements of the harmonic beam (40 MHz) of both transducers showed relatively low signal strength in the near field compared with both (20 and 40 MHz) fundamental beams. For the focused transducer, THI suppressed the second stent echo up to 14 dB compared with fundamental imaging. No significant reduction in stent artifact imaging was observed for the unfocused IVUS element.     

Benefits of tissue harmonic imaging in the evaluation of abdominal and pelvic lesions

Background: We compared tissue harmonic imaging (THI) and conventional ultrasonography to determine whether THI improves image quality and facilitates lesion characterization. Methods: Eighty-nine various abdominal or pelvic lesions in 71 patients(34 men and 37 women; age range = 3–90 years, median age = 52 years) were evaluated with conventional ultrasonography and THI. Examinations were performed with frequencies of 2–5 MHz. All the images were stored on a hard disk and evaluated separately by three radiologists. Results: According to the interpreters, THI improved overall image quality in 67 (74%) to 76 (84%) and lesion characterization in 28 (31%) to 36 (40%) of 89 lesions when compared with conventional ultrasonography. All three observers agreed that image quality and lesion characterization were improved in 62% and 17% of the lesions, respectively. Lesion groups containing five or more lesions were compared for any difference of improvement in overall image quality and lesion characterization. For overall image quality, a significant difference was found (p < 0.05). For lesion characterization, there was no significant difference between groups (p > 0.05). Conclusion: THI improved overall image quality and lesion characterization.     

Comparing differential tissue harmonic imaging with tissue harmonic and fundamental gray scale imaging of the liver.

OBJECTIVE: The purpose of this study was to compare fundamental gray scale sonography, tissue harmonic imaging (THI), and differential tissue harmonic imaging (DTHI) for depicting normal and abnormal livers. METHODS: The in vitro lateral resolution of DTHI, THI, and sonography was assessed in a phantom. Sagittal and transverse images of right and left hepatic lobes of 5 volunteers and 20 patients and images of 27 liver lesions were also acquired. Three independent blinded readers scored all randomized images for noise, detail resolution, image quality, and margin (for lesions) on a 7-point scale. Next, images from the same location obtained with all 3 modes were compared blindly side by side and rated by all readers. Contrast-to-noise ratios were calculated for the lesions, and the depth of penetration (centimeters) was determined for all images. RESULTS: In vitro, the lateral resolution of DTHI was significantly better than fundamental sonography (P = .009) and showed a trend toward significance versus THI (P = .06). In the far field, DTHI performed better than both modes (P < .04). In vivo, 450 images were scored, and for all parameters, DTHI and THI did better than sonography (P < .002). Differential tissue harmonic imaging scored significantly higher than THI with regard to detail resolution and image quality (P < .001). The average increase in penetration with THI and DTHI was around 0.6 cm relative to sonography (P < .0001). The contrast-to-noise ratio for DTHI showed a trend toward significance versus THI (P = .06). Side-by-side comparisons rated DTHI better than THI and sonography in 54% of the cases (P < .007). CONCLUSIONS: Tissue harmonic imaging and DTHI do better than fundamental sonography for hepatic imaging, with DTHI being rated the best of the 3 techniques.     

Tissue harmonic imaging of thyroid nodules: initial experience.

OBJECTIVE: To determine the impact of tissue harmonic imaging on visualization of the thyroid and gray scale contrast between thyroid nodules and adjacent thyroid parenchyma. METHODS: A prospective study was performed on 144 patients (148 lesions) undergoing sonographically guided fine-needle biopsy. The fundamental frequency and tissue harmonic images were obtained on a scanner with a wideband 7.5-MHz linear probe. One hundred forty-two benign nodules, 2 papillary carcinomas, 1 anaplastic carcinoma, and 1 metastatic lesion were found. In 1 case a suggestion of a follicular carcinoma was raised, and in 1 case no diagnostic material was obtained. The gray scale intensity of the lesions and adjacent thyroid tissue was measured with graphics software, and the gray scale contrast between lesions and adjacent thyroid tissue was calculated. Additionally, the overall conspicuity and border definition were evaluated by 2 independent observers. RESULTS: Tissue harmonic imaging improved the gray scale contrast between thyroid nodules and adjacent thyroid parenchyma in 116 lesions (78.4%). The overall conspicuity and border definition were improved or equal in the harmonic mode for most lesions. CONCLUSIONS: The tissue harmonic imaging technique used as an adjunct to conventional thyroid sonography may improve lesion detectability and characterization.     

Advantages of color B-mode imaging with contrast optimization in sonography of low-contrast musculoskeletal lesions and structures in the foot and ankle.

OBJECTIVE: The purpose of this study was to evaluate the utility of color B-mode imaging with contrast optimization in evaluating low-contrast lesions of the foot and ankle (Morton neuromas and plantar fasciitis). METHODS: The sonographic examinations of 49 consecutive patients with a diagnosis of plantar fasciitis or Morton neuroma imaged with both conventional gray scale imaging and color B-mode imaging with contrast optimization (Photopic; Siemens Medical Solutions, Mountain View, CA) were reviewed. In every patient, matched pairs of images obtained with conventional gray and color maps (Photopic) were acquired and stored as DICOM (Digital Imaging and Communications in Medicine) images on a sonographic workstation. Each image was assessed independently by 2 musculoskeletal radiologists trained in musculoskeletal sonography for overall image contrast (lesion to background), conspicuity of regional tissue boundaries, visualization of deep tissue boundaries, and how well the internal characteristics of the structure were visualized. RESULTS: Three-way analysis of variance showed that Photopic imaging resulted in statistically significantly improved overall image contrast, definition of regional soft tissue boundaries, including deep soft tissue boundaries, and depiction of the internal characteristics of the structure being examined. CONCLUSIONS: Color imaging with contrast optimization improves overall image contrast and better defines deep soft tissue boundaries and the internal morphologic characteristics of Morton neuromas and the plantar fascia compared with conventional gray scale imaging.     

影响乳腺癌穿刺活检与术后病理分子分型差异的自动乳腺全容积成像特征

目的探讨影响乳腺癌粗针穿刺活检与术后病理分子分型差异的自动乳腺全容积成像（ABVS）特征。 方法回顾性分析2014年11月至2020年10月东部战区总医院收治的63例乳腺癌患者,共63个病灶。所有患者行改良根治术前均行粗针穿刺活检及ABVS检查。比较术前粗针穿刺活检与术后标本分子分型存在差异组（有差异组）与二者病理结果一致组（无差异组）ABVS特征的差异,并采用Logistic回归分析手术前后分子分型差异的独立影响因素。 结果手术病理结果显示,Luminal A型15个（23.8%）,Luminal B型39个（61.9%）,HER-2过表达型6个（9.5%）,三阴型3个（4.8%）。其中14个病灶的粗针穿刺活检与术后分子分型之间存在差异。有差异组（n=14）与无差异组（n=49）的肿块最大径、边界、形态、边缘及汇聚征比较,差异具有统计学意义（P均＜0.05）。Logistic回归分析结果表明,伴有汇聚征（OR=0.113,95%CI：0.015~0.865）、形态不规则（OR=0.117,95%CI：0.015~0.912）、边界模糊（OR=0.171,95%CI：0.029~0.992）以及边缘有毛刺（OR=12.576,95%CI：1.783~88.717）是粗针穿刺活检与术后分子分型差异的独立影响因素（P均＜0.05）。 结论ABVS在一定程度能够指导粗针穿刺活检,减少穿刺活检病理与术后病理分子分型的差异,提高穿刺诊断准确性,为临床医师提供可靠的诊断依据和参考信息。     

Application of the breast imaging reporting and data system final assessment system in sonography of palpable breast lesions and reconsideration of the modified triple test.

OBJECTIVE: The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions. METHODS: Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05). RESULTS: The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations. CONCLUSIONS: The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.     

磁共振扩散加权成像技术对可疑乳腺癌的鉴别诊断价值

目的探讨乳腺磁共振扩散加权成像中表观扩散系数(apparent diffusion coefficient,ADC)值、指数表观扩散系数(exponential apparent diffusion coefficient,eADC)值和相对表观扩散系数(relative apparent diffusion coefficient,rADC)值,结合MRI平扫对可疑乳腺癌的诊断和鉴别价值。材料与方法收集41例患者均行扩散加权磁共振成像(diffusion weighted imaging,DWI)成像检查并行BI-RADS分级为Ⅳ级,且经手术病理证实。在病变感兴趣区测量ADC值、eADC值和rADC值;采取组间两两比较采用t检验,P<0.05其良、恶性差异有统计学意义。同时,按ADC值大小进行良、恶性分布情况统计,均以手术病理结果为金标准,进行统计学分析。结果在两两比较中,恶性病变ADC、rADC值低于良性病变,eADC值高于良性病变,其差异具有统计学意义(P<0.05)。以病理诊断结果为金标准,以1.440×10^-3 mm^2/s为鉴别乳腺良、恶性病变的临界值,敏感性为85.7%,特异度为55.0%,准确度为70.7%。以DWI中ADC值<1.440×10^-3 mm^2/s作为恶性的评判标准,Kappa=0.712,与病理诊断一致性好。结论扩散加权成像技术(ADC值、eADC值和rADC值)是磁共振检查鉴别可疑性乳腺癌可靠的指标;结合MRI平扫对BI-RADS分类Ⅳ级病变良恶性鉴别更具有重要的价值,对临床治疗具有指导意义。     

Ultrasonography of the pancreas. 2. Harmonic imaging

Tissue harmonic imaging (THI) is a relatively new ultrasonographic imaging modality which has been implemented in many modern scanners. As several previous studies have pointed out, THI can help to overcome some shortcomings of conventional B-mode ultrasonography (US). The aim of this article is to give a compact summary of the potentials of THI, focused on pancreatic imaging. Beginning with a recapitulation of the technical background of THI, the particularities and suitable applications of THI in US of the pancreas are discussed. Examination protocols and typical indications are presented together with example images. Finally, new trends and developments in B-mode sonography of the pancreas such as panorama US, compound imaging, and photopic US are mentioned     

Improved imaging of hepatic metastases with delayed pulse inversion harmonic imaging using a contrast agent SH U 508A: preliminary study

To investigate the feasibility of delayed pulse-inversion harmonic imaging (PIHI) with the SH U 508A to improve imaging of hepatic metastases, we evaluated 20 patients with known hepatic metastases. Conventional ultrasound (US) was performed before administration, and PIHI was performed 5 min after a bolus injection of 4 G of microbubble contrast agent (300 mg/mL of SH U 508A). Intense, homogeneous enhancement in the liver parenchyma was seen in all patients on delayed PIHI. In 10 patients (50%), 1 or more focal liver lesions that were not seen on unenhanced imaging were detected on delayed PIHI. When comparing 55 lesions that were seen on both techniques, delayed PIHI was superior to unenhanced imaging in terms of lesion conspicuity and lesion-to-liver contrast (p < 0.001, respectively). Delayed PIHI with SH U 508A can improve conspicuity of hepatic metastases and reveal focal liver lesions that are not detected on unenhanced imaging.     

Ultrasonographic evaluation of focal hepatic lesions: comparison of pulse inversion harmonic,tissue harmonic,and conventional imaging techniques.

A prospective study was performed to evaluate whether pulse inversion harmonic imaging and tissue harmonic imaging improve the lesion conspicuity and change ultrasonographic characteristics of focal hepatic lesions. Three radiologists evaluated 97 focal hepatic lesions by consensus: cirrhosis‐related nodules (n = 23), metastases (n = 23), hemangiomas (n = 27), and cysts (n = 24). In our study, pulse inversion harmonic imaging was judged superior to both tissue harmonic imaging and conventional imaging in conspicuity and overall quality for cirrhosis‐related nodules, metastases, and cysts (P < 0.05). Compared with conventional imaging, both pulse inversion harmonic imaging and tissue harmonic imaging provided better conspicuity, clearer internal echogenicity, and stronger through‐transmission of cysts (P < 0.05). Pulse inversion harmonic imaging was judged to be better in depicting internal morphology for cirrhosis‐related nodules and metastases than conventional imaging (P < 0.05). For hemangiomas, no statistically significant difference was found in all parameters except better posterior enhancement by tissue harmonic imaging than other techniques. In conclusion, pulse inversion harmonic imaging showed the best conspicuity and also enhanced characteristics of both cystic and solid hepatic lesions. Tissue harmonic imaging was judged superior to conventional imaging in evaluating cysts but was not beneficial for solid lesions. The results of this trial may be specific to the machine used for this study.     

Display of 3-dimensional ultrasonographic images for interventional procedures: volume-rendered versus multiplanar display.

OBJECTIVE: The goal of this project was to assess the display of 3-dimensional ultrasonographic images as used for interventional procedures, particularly the conspicuity of various targets and interventional devices, comparing volume-rendered (VR) versus multiplanar reformatted (MPR) display approaches. METHODS: A series of ultrasonographic phantoms were made from a petroleum gel with cornstarch used to vary the echo texture. Three-dimensional ultrasonographic target and device conspicuity were judged with a 5-point visual rating scale. The MPR image was considered the reference standard. Volume-rendered image conspicuity was judged for combinations of 7 different postprocessing display parameters and compared with MPR images. RESULTS: Definite visualization of the embedded objects occurred in 92% of MPR and 13% of VR test situations (P < .0001). Volume-rendered display was associated with a mean conspicuity degradation of 2.6 on a scale of 0 through 4 (P < .0001) compared with MPR methods. The proportion of satisfactory VR images was greatest in test situations with a large degree of difference of echogenicity between the background medium and the embedded object. The transparent-type postprocessing rendering modes were superior to the surface-type rendering modes (P < .0001). CONCLUSIONS: Current 3-dimensional ultrasonographic MPR imaging display in a solid organ environment provides better visualization performance of target and needle conspicuity than VR image display when there are not large differences in the signal levels of targeted structures and devices compared with surrounding tissues. The difficulty in viewing both target and device with VR imaging may restrict its ability to guide interventional procedures in some clinical situations.     

Breast hemangiomas: Correlation between imaging and pathologic findings

Hemangiomas are benign vascular tumors that are rare in the breast. A high percentage of hemangiomas are diagnosed incidentally during imaging examinations. They have mammographic, sonographic, and pathologic characteristics that allow radiologists and pathologists to diagnose them. We present four different cases of breast hemangiomas showing their mammographic and sonographic features. Two were diagnosed with an 18‐gauge core needle biopsy and they underwent surgical excision. The other two cases were diagnosed with a 14‐gauge core needle biopsy and their radiologic and pathologic appearances were concordant with breast hemangiomas, so they did not need surgical excision and are being followed. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:512–517, 2012     

Pathologic breast conditions in childhood and adolescence: evaluation by sonographic diagnosis.

OBJECTIVE: The growing awareness of female breast cancer has led to increased sensitivity toward pathologic breast conditions in children and adolescents. Thus, approximately 15% of patients in child and adolescent gynecology are referred for the first time because of conspicuous features of the breast such as pain, palpable masses, and other findings on visual inspection. The aim of this study was to analyze the underlying diagnoses and diseases and determine the status of breast sonography in the diagnostic process. METHODS: The study population consisted of 62 female patients between 8 weeks and 20 years of age (1997-2002) who were examined clinically, followed by standardized sonography (7.5-13 MHz, conventional B-mode panoramic sonography). Presumed diagnoses were confirmed by biopsy in some patients (n = 16) and by follow-up with clinical examination and sonography in most cases (n = 46). RESULTS: The clinical and sonographic evaluation confirmed 4 main groups of diagnoses: benign tumors (15), developmental disturbances (14), cystic changes (11), and inherent defects (7). In the remaining cases, the findings were no abnormality (9), nipple discharge without evidence of pathologic or morphologic correlates (3), abscesses (2), and epidermoid cyst (1). CONCLUSIONS: Knowledge of regular breast development and its variants is essential for the physician. Given knowledge of the sonographic appearance of physiologic breast development and specific lesions, breast sonography is most helpful in identifying and characterizing abnormalities and guiding further investigation.     

Fast T2-weighted liver MR imaging: comparison among breath-hold turbo-spin-echo, HASTE, and inversion recovery (IR) HASTE sequences

Background: To evaluate the diagnostic efficacy of fast T2-weighted magnetic resonance (MR) imaging sequences on image quality, hepatic lesion detection, and lesion conspicuity. Methods: Three breath-hold, fast T2-weighted sequences with turbo-spin-echo (TSE), half-Fourier acquisition single-shot TSE (HASTE), and inversion recovery (IR) HASTE techniques were examined for 43 lesions in 20 consecutive patients. Evaluation was performed qualitatively on image quality and lesion detectability and quantitatively on lesion conspicuity by using lesion/liver signal-intensity and contrast-to-noise ratios. Results: Artifacts were significantly less present on the HASTE sequence (p < 0.01). Both TSE and HASTE sequences detected 39 lesions (91% each); the IR HASTE sequence detected 37 (86%). IR HASTE sequence showed a significantly higher signal-intensity ratio than did the others (p < 0.01). Conclusions: Breath-hold TSE versus breath-hold HASTE or IR HASTE is still the most robust sequence in lesion detection, image quality, and lesion conspicuity. However, the HASTE sequence offers good lesion detection and image quality, and the IR HASTE has a better signal-intensity ratio. Received: 15 January 1999/Accepted: 24 March 1999     

Application of power Doppler vocal fremitus sonography in breast lesions.

OBJECTIVE: The purpose of this study was to illustrate the method and use of power Doppler vocal fremitus (PDVF) sonography in the detection and diagnosis of breast lesions. METHODS: One case was evaluated by various sonographic parameters and equipment to determine how the VF images were affected. Cases illustrative of a broad range of breast conditions were also collected. Each image pair consisted of B-mode and VF images to maintain an identical projection and to illustrate the influence of PDVF sonography. RESULTS: With B-mode and PDVF sonography, we evaluated and compared various breast conditions, including normal anatomic structures and abnormal lesions. We found that PDVF sonography is useful for distinguishing abnormal masses from normal tissue, such as differentiating between isoechoic tumors and isoechoic glandular tissues, and discriminating entrapped fat lobules from isoechoic tumors. Furthermore, PDVF sonography was useful for determining whether intracystic echoes are attached to the cyst wall. CONCLUSIONS: Power Doppler VF imaging is a valuable adjunct tool to B-mode sonography in the evaluation of breast lesions.     

Risk of malignancy in solid breast nodules according to their sonographic features.

OBJECTIVE: The purpose of this study was to assess the risk of malignancy for each type of sonographic feature in solid breast nodules. METHODS: The study included 304 patients from the Department of Gynecology and Obstetrics of the Federal University of Goiás who had solid breast nodules. A medical trainee, working under the supervision of a preceptor, obtained the sonographic images of the breast, and the features were recorded in a questionnaire. Each sonographic feature was analyzed and compared with the anatomic and pathologic findings after the lesion was excised. RESULTS: Of the 304 patients included in the study, 292 (96%) had a conclusive diagnosis. Among these women, 216 (74%) had benign tumors and 76 (26%) had malignant tumors. The odds ratio of malignancy in breast nodules, as calculated by multivariate analysis, was as follows: lesions without circumscribed margins, 17.02 (95% confidence interval, 5.28-54.90); lesions with heterogeneous echo texture, 7.70 (2.99-19.84); lesions with thickened Cooper ligaments, 15.61 (1.08-225.10); nodules whose anteroposterior dimension was larger than their width, 3.29 (1.09-9.96); those with an anterior echogenic rim, 2.59 (0.80-8.40); and those with posterior shadowing, 1.57 (0.62-4.01). Among the 133 cases that had all the sonographic features of a benign lesion, 3 nodules (2.3%) had a histologic diagnosis of malignant. CONCLUSIONS: Sonography is a diagnostic method that can help establish the differentiation between benign and malignant solid tumors. A lack of circumscribed margins, heterogeneous echo patterns, thickened Cooper ligaments, and an increased anteroposterior dimension can indicate a higher probability of malignancy in solid breast nodules.     

Hepatic angiomyolipoma

The imaging and pathological appearances of a hepatic angiomyolipoma are presented. On ultrasound (US), the mass was well-defined and echogenic. On computed tomography (CT), the lesion appeared of soft tissue density with peripheral foci of lower density. The case illustrates the difficulty of detecting the fatty content of a tumor by CT when the fatty content represents only a small portion of the lesion. Fine-needle aspiration (FNA) cytology and needle biopsy did not yield diagnostic material, and the tumor was resected.An invited commentary on this article follows on pp. 552–553.