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Diagnostic Accuracy of Phase-Inversion Tissue Harmonic Imaging Versus Fundamental B-Mode Sonography in the Evaluation of Focal Lesions of the Kidney

¹ Department of Diagnostic Radiology, RWTH Aachen University Hospital, Pauwelsstr. 30, Aachen D 52057, Germany.
² Institute for Biometrics, RWTH Aachen University Hospital, Aachen D 52057, Germany.

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.

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