title: Diagnostic accuracy of phase-inversion tissue harmonic imaging versus fundamental B-mode sonography in the evaluation of focal lesions of the kidney.
abstract: OBJECTIVE
  We compared phase-inversion tissue harmonic imaging with fundamental B-mode sonography in the evaluation of focal lesions of the kidney.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Diagnostic Radiology, RWTH Aachen University Hospital, Pauwelsstr. 30, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Schmidt
authors.forename: Christian
authors.initials: C
authors.lastname: Hohl
authors.forename: Patrick
authors.initials: P
authors.lastname: Haage
authors.forename: Marcus
authors.initials: M
authors.lastname: Blaum
authors.forename: Dagmar
authors.initials: D
authors.lastname: Honnef
authors.forename: Claudia
authors.initials: C
authors.lastname: Weibeta
authors.forename: Gundula
authors.initials: G
authors.lastname: Staatz
authors.forename: R W
authors.initials: RW
authors.lastname: Günther
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003199:Computer Systems; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography