Tissue harmonic imaging: is it a benefit for bile duct sonography?
OBJECTIVE
Our purpose was to compare tissue harmonic imaging with conventional sonography of the biliary tract.


METHODS
Eighty patients with suspect biliary disease had conventional sonography and tissue harmonic imaging with an ATL 3000 or 5000 scanner in a 6-month interval. Final diagnoses included malignant biliary obstruction (n = 30), choledocholithiasis (n = 16), sclerosing cholangitis (n = 4), normal or nonobstructed ducts (n = 16), and miscellaneous conditions (n = 14). Similar images were taken with each technique in terms of projection, field of view, focal zone selection, and evidence of disease. Two separate observers blinded to patient data and technique reviewed and graded images individually for the appearance of the lumen of the bile ducts, the length of the visible duct, the appearance of the duct wall, the presence of any intraluminal masses, and the appearance of associated acoustic shadows. Images were graded from zero to 3, with 3 being the best.


RESULTS
The median of the 546 tissue harmonic images was one grade higher than the median for the corresponding conventional images (p < 0.0001). Improvements with tissue harmonic imaging included better sharpness of the duct walls (p < 0.01), a clearer lumen (p < 0.0001), identification of a longer length of the common bile duct (p < 0.0001), and improved detection of intraluminal masses (p < 0.006). Acoustic shadows were better defined and blacker with tissue harmonic imaging (p < 0.007).


CONCLUSIONS
Improvement in contrast and reduction of side lobe artifacts with tissue harmonic imaging enhance visualization of the biliary ducts. Tissue harmonic imaging is now our routine technique for bile duct examination.
Department of Medical Imaging, Toronto General Hospital, University Health Network, 200 Elizabeth St., Toronto, Ontario, M5G 2C4 Canada.
D
D
Ortega
P N
PN
Burns
D
D
Hope Simpson
S R
SR
Wilson
D016477:Artifacts; D001652:Bile Ducts / Q000000981:diagnostic imaging*; D001660:Biliary Tract Diseases / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography / Q000379:methods