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Comparison of Conventional Sonography, Real-Time Compound Sonography, Tissue Harmonic Sonography, and Tissue Harmonic Compound Sonography of Abdominal and Pelvic Lesions

Suna Özhan Oktar¹, Cem Yücel, Hakan Özdemir, Asl Ulutürk and Sedat Ik

¹ All authors: Department of Radiology, Gazi University, School of Medicine, Besevler, Ankara 06510, Turkey.

View larger version (145K): [in a new window]   Fig. 1A. —35-year-old woman with multiple gallbladder stones. Conventional longitudinal sonogram of gallbladder reveals multiple millimetric stones (solid arrows). Speckling and clutter (open arrow) are also seen.

View larger version (146K): [in a new window]   Fig. 1B. —35-year-old woman with multiple gallbladder stones. Spatial compound sonogram reveals image quality improved by elimination of artifacts such as speckling and clutter (open arrow, A). Acoustic shadows of stones are narrower and less conspicuous than on conventional sonography (A).

View larger version (146K): [in a new window]   Fig. 1C. —35-year-old woman with multiple gallbladder stones. Tissue harmonic sonogram provides clearer and darker posterior acoustic shadow than that provided by conventional sonography (A) or spatial compounding (B). Improvement may be related to higher receiving frequency and narrower dynamic range.

View larger version (134K): [in a new window]   Fig. 1D. —35-year-old woman with multiple gallbladder stones. Tissue harmonic compound sonogram provides better delineation of stones while preserving posterior acoustic echo pattern. Thus, overall image quality is superior to that of conventional (A), spatial compound (B), and tissue harmonic (C) sonography.

View larger version (139K): [in a new window]   Fig. 2A. —67-year-old woman with ureteral stone. Conventional sonogram reveals right ureteral stone (arrow) with proximal dilatation.

View larger version (130K): [in a new window]   Fig. 2B. —67-year-old woman with ureteral stone. Spatial compound sonogram shows dilated ureter as echo-free structure with stone more clearly depicted than on conventional sonogram (A). Acoustic shadowing is preserved.

View larger version (134K): [in a new window]   Fig. 2C. —67-year-old woman with ureteral stone. Tissue harmonic sonogram accentuates posterior acoustic shadow of stone.

View larger version (120K): [in a new window]   Fig. 2D. —67-year-old woman with ureteral stone. Tissue harmonic compound sonogram reveals stone and acoustic shadowing even more clearly than spatial compounding (B) and tissue harmonic sonography (C).

View larger version (147K): [in a new window]   Fig. 3A. —49-year-old man with renal cysts. Conventional sonogram shows eccentrically located simple cyst anterior relative to kidney and another indeterminate hypoechoic lesion (arrow) at upper pole.

View larger version (113K): [in a new window]   Fig. 3B. —49-year-old man with renal cysts. Spatial compound sonogram reveals suppression of artifacts, which allows better depiction of cystic nature of lesions, especially lesion located in upper lobe. Compounded image provides better depiction of cyst capsule and septation than does conventional sonogram (A).

View larger version (152K): [in a new window]   Fig. 3C. —49-year-old man with renal cysts. On tissue harmonic sonogram, elimination of artifacts allows slightly better depiction than conventional sonography (A) but still is not helpful for characterizing lesion in upper pole. Lack of sufficient detail for characterization may be due to decreased penetration of tissue harmonic sonography with increased depth.

View larger version (124K): [in a new window]   Fig. 3D. —49-year-old man with renal cysts. Tissue harmonic compound sonogram provides better lesion definition and improved overall image quality with better delineation of boundaries between different structures than other types of sonograms (A–C).

View larger version (166K): [in a new window]   Fig. 4A. —18-year-old woman with complicated ovarian cyst. Conventional sonogram is degraded by artifacts and shows indeterminate hypoechoic mass (arrow).

View larger version (142K): [in a new window]   Fig. 4B. —18-year-old woman with complicated ovarian cyst. Speckle and clutter suppression on spatial compound sonogram results in smoother image texture and allows better depiction of solid and cystic components of lesion than conventional sonogram (A).

View larger version (140K): [in a new window]   Fig. 4C. —18-year-old woman with complicated ovarian cyst. Tissue harmonic sonogram reveals nature of lesion better than conventional sonogram (A).

View larger version (154K): [in a new window]   Fig. 4D. —18-year-old woman with complicated ovarian cyst. Tissue harmonic compound sonogram provides better differentiation between cystic and solid components and gives more precise details than is provided by other types of sonograms. Delineation of boundaries of cyst is also significantly improved compared with that in other types of sonograms (A–C).

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