Korean J Radiol.  2002 Mar;3(1):38-44. 10.3348/kjr.2002.3.1.38.

Sonographic Evaluation of Breast Nodules: Comparison of Conventional, Real-Time Compound, and Pulse-Inversion Harmonic Images

• Seo BK
• Oh YW
• Kim HR
• Kim HW
• Kang CH
• Lee NJ
• Kim JH
• Park BJ
• Cho KR
• Lee JY
• Lee KY
• Bae JW

• KMID: 1758445
• DOI: http://doi.org/10.3348/kjr.2002.3.1.38

Abstract

OBJECTICE: To compare the use of conventional, real-time compound, and pulse-inversion harmonic imaging in the evaluation of breast nodules.
MATERIALS AND METHODS
Fifty-two breast nodules were included in this study, conducted between May and December 2000, in which conventional, real-time compound, and pulse-inversion harmonic images were obtained in the same plane. Three radiologists, each blinded to the interpretations of the other two, evaluated the findings, characterizing the lesions and ranking the three techniques from grade 1, the worst, to grade 3, the best. Lesion conspicuity was assessed, and lesions were also characterized in terms of their margin, clarity of internal echotexture, and clarity of posterior echo pattern. The three techniques were compared using Friedman's test, and interobserver agreement in image interpretation was assessed by means of the intraclass correlation coefficient.
RESULTS
With regard to lesion conspicuity, margin, and internal echotexture of the nodules, real-time compound imaging was the best technique (p < 0.05); in terms of posterior echo pattern, the best was pulse-inversion harmonic imaging (p < 0.05). Real-time compound and pulse inversion harmonic imaging were better than conventional sonography in all evaluative aspects. Interobserver agreement was greater than moderate.
CONCLUSION
Real-time compound and pulse-inversion harmonic imaging procedures are superior to conventional sonography in terms of both lesion conspicuity and the further characterization of breast nodules. Real-time compound imaging is the best technique for evaluation of the margin and internal echotexture of nodules, while pulse-inversion harmonic imaging is very effective for the evaluation of the posterior echo patterns.

Keyword

Breast, US; Ultrasound (US); Ultrasound (US), technology; Ultrasound (US), comparative studies

MeSH Terms

Breast Neoplasms/*ultrasonography
Comparative Study
Female
Fibrocystic Disease of Breast/*ultrasonography
Human
Middle Age
Ultrasonography, Mammary/*methods

Figure

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  Fig. 1 Sonograms of a 56-year-old woman show an oval-shaped, microlobulated and spiculated marginated, hypoechoic nodule. In lesion conspicuity and margin depiction, real-time compound (B) and pulse-inversion harmonic imaging (C) are better than conventional scanning (A). Pathologic examination showed that the case was invasive ductal carcinoma.

• 

  Fig. 2 Sonograms of a 46-year-old woman demonstrate an irregular-shaped, heterogeneously hypoechoic nodule with angular and branching margin. Internal microcalcifications (arrows) are seen within the nodule. Real-time compound imaging (B) is the best technique for evaluation of the margin and internal echotexture, compared to conventional (A) and pluse-inversion harmonic imaging (B). Pathologic examination indicated the presence of invasive ductal carcinoma.

• 

  Fig. 3 Sonograms of a 35-year-old woman depict a septated cyst. The internal transverse thin septum within the cyst is more clearly demonstrated by real-time compound (B) and pulse-inversion harmonic imaging (C) than by conventional scanning (A).

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  Fig. 4 Sonograms of 32-year-old woman reveal a well-defined, oval-shaped, heterogeneous isoechoic nodule. The heterogeneous internal echotexture is more clearly visualized by real-time compound imaging (B) than conventional (A) and pulse-inversion harmonic imaging (B) and an internal microcalcification (curved arrow) is revealed by pulse-inversion harmonic imaging (C). Pathologic examination showed that the condition was atypical ductal hyperplasia.

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  Fig. 5 Sonograms of a 52-year-old woman show a well-defined, hypoechoic, round nodule with internal microcalcifications. Posterior shadowing (arrows) due to microcalcifications is more clearly visualized at pulse-inversion harmonic imaging (C) than conventional (A) and real-time compound imaging (B). Pathologic examination indicated the presence of degenerating fibroadenoma.

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