European Radiology

, Volume 14, Issue 6, pp 1109–1117 | Cite as

Phase-inversion tissue harmonic imaging compared with conventional B-mode ultrasound in the evaluation of pancreatic lesions

  • Christian Hohl
  • Thorsten Schmidt
  • Patrick Haage
  • Dagmar Honnef
  • Marcus Blaum
  • Gundula Staatz
  • Rolf W. Guenther


The aim of this study was to compare the diagnostic sensitivity, specificity, and image quality of conventional B-mode US (BM) and phase-inversion tissue harmonic imaging (PTHI) regarding pancreatic pathology. In a prospective study, 107 patients, aged between 28 and 85 years, underwent US examinations of the pancreas with both BM and PTHI in a randomly chosen order. As diagnostic reference, either contrast-enhanced CT or MRI examinations of the upper abdomen were obtained in all patients. Sensitivity and specificity were evaluated using the Student’s t test. Differences in overall image quality, lesion conspicuity, fluid–solid differentiation, and delineation of the pancreatic tail were analyzed using Wilcoxon’s signed ranks test and Bowker’s symmetry test. Sixteen of 107 examined patients (15%) were non-diagnostic and excluded due to technical limitations such as abdominal gas. A total of 60 pancreatic lesions (cysts, acute pancreatitis, dilatation of the pancreatic duct, calcifications, and solid tumors) were diagnosed by CT or MRI. Phase-inversion tissue harmonic imaging had a higher sensitivity of 70% (14 of 20) than BM (60%; 24 of 40) for the detection of pancreatic lesions; however, the difference was not statistically significant (p=0.46). In the assessment of lesions <1 cm of size, PTHI had a sensitivity of 70% and BM 46.7%, whereby the difference again was not statistically significant. Phase-inversion tissue harmonic imaging proved to be superior to BM regarding overall image quality (p<0.0001), lesion conspicuity (p=0.0045), and fluid–solid differentiation (p=0.0002), as well as the delineation of the pancreatic tail (p<0.0001). These differences were statistically significant. The statistically significant improvement of image quality with regards to lesion conspicuity, fluid–solid differentiation, and delineation of the pancreatic tail favors the use of PTHI when evaluating the pancreas with US. Sensitivity for pancreatic lesions is increased with PTHI in comparison with conventional sonography (BM), especially in lesions <1 cm in diameter, although the difference was not statistically significant.


Ultrasonography Harmonic imaging Pancreas Pancreatic carcinoma Pancreatitis 


  1. 1.
    Muir TG, Carstensen EL (1980) Prediction of nonlinear acoustic effects at biomedical frequencies and intensities. US Med Biol 6:345–357Google Scholar
  2. 2.
    Carstensen EL, Law WK, McKay ND, Muir TG (1980) Demonstration of nonlinear acoustical effects at biomedical frequencies and intensities. US Med Biol 6:359–368Google Scholar
  3. 3.
    Starritt HC, Perkins MA, Duck FA, Humphrey VF (1985) Evidence for ultrasonic finite-amplitude distortion in muscle using medical equipment. J Acoust Soc Am 77:302–306PubMedGoogle Scholar
  4. 4.
    Starritt HC, Duck FA, Hawkins AJ, Humphrey VF (1986) The development of harmonic distortion in pulsed finite-amplitude US passing through liver. Phys Med Biol 31:1401–1409CrossRefPubMedGoogle Scholar
  5. 5.
    Whittingham TA (1999) Tissue harmonic imaging. Eur Radiol 9:S323–S326PubMedGoogle Scholar
  6. 6.
    Burns PN, Powers JE, Hope Simpson D, Uhlendorf V, Fritsch T (1996) Harmonic imaging: principles and preliminary results. Angiology 47:63–73Google Scholar
  7. 7.
    Shapiro RS, Wagreich J, Parsons RB, Stancato-Pasik A, Yeh HC, Lao R (1998) Tissue harmonic imaging sonography: evaluation of image quality compared with conventional sonography. Am J Roentgenol 171:1203–1206Google Scholar
  8. 8.
    Hann LE, Bach AM, Cramer LD, Siegel D, Yoo HH, Garcia R (1999) Hepatic sonography: comparison of tissue harmonic and standard sonography techniques. Am J Roentgenol 173:201–206Google Scholar
  9. 9.
    Treadwell MC, Seubert DE, Zador I, Goyert GL, Wolfe HM (2000) Benefits associated with harmonic tissue imaging in the obstetric patient. Am J Obstet Gynecol 182:1620–1623Google Scholar
  10. 10.
    Choudhry S, Gorman B, Charboneau JW, Tradup DJ, Beck RJ, Koler JM, Groth DS (2000) Comparison of tissue harmonic imaging with conventional US in abdominal disease. Radiographics 20:1127–1135PubMedGoogle Scholar
  11. 11.
    Mulvagh SL, Foley DA, Belohlavek M, Seward JB (1998) Image enhancement by noncontrast harmonic echocardiography. Part I. Qualitative assessment of endocardial visualization. Mayo Clin Proc 73:1062–1065PubMedGoogle Scholar
  12. 12.
    Tanaka S, Oshikawa O, Sasaki T, Ioka T, Tsukuma H (2000) Evaluation of tissue harmonic imaging for the diagnosis of focal liver lesions. US Med Biol 26:183–187CrossRefGoogle Scholar
  13. 13.
    Ortega D, Burns PN, Hope-Simpson D, Wilson SR (2001) Tissue harmonic imaging: Is it a benefit for bile duct sonography? Am J Roentgenol 176:653–659Google Scholar
  14. 14.
    Jang HJ, Lim HK, Lee WJ, Kim SH, Kim KA, Kim EY (2000) Ultrasonographic evaluation of focal hepatic lesions: comparison of pulse inversion harmonic, tissue harmonic, and conventional imaging techniques. J US Med 19:293–299Google Scholar
  15. 15.
    Stiskal M, Steinbach R, Obholzer G, Frank W, Fischer H, Czembriek H (2000) Tissue harmonic imaging sonography: Is the image quality in abdominal US improved? Rofo 172:1006–1010CrossRefGoogle Scholar
  16. 16.
    Rosenthal SJ, Jones PH, Wetzel LH (2001) Phase inversion tissue harmonic sonographic imaging: a clinical utility study. Am J Roentgenol 176:1393–1398Google Scholar
  17. 17.
    Chapman CS, Lazenby JC (1997) US imaging system employing phase inversion subtraction to enhance the image. US patent 5,632,277Google Scholar
  18. 18.
    Niederau C, Grendell JH (1992) Diagnosis of pancreatic carcinoma. Pancreas 7:66–86PubMedGoogle Scholar
  19. 19.
    Boudghene FP, Deslandes PM, LeBlanche AF, Bigot JMR (1994) US and CT imaging features of intrapancreatic metastasis. J Comput Assist Tomogr 18:905–910PubMedGoogle Scholar
  20. 20.
    Reuss J, Rettenmaier G (1993) Transabdominal ultrasonography in pancreatic diseases. Schweiz Med Wochenschr 123:1049–1058PubMedGoogle Scholar
  21. 21.
    Gebel M, Stiehl M, Freise J (1985) Value of sonographic imaging of the pancreatic duct for the diagnosis of chronic pancreatitis and pancreatic cancer compared with ERCP. Ultraschall Med 6:127–130PubMedGoogle Scholar
  22. 22.
    Böttger T, Engelmann R, Seifert JK, Löw R, Junginger T (1998) Preoperative diagnostics in pancreatic carcinoma: Would less be better? Langenbeck’s Arch Surg 383:243–248Google Scholar
  23. 23.
    Venu RP, Brown RD, Halline AG (2002) The role of endoscopic retrograde cholangiopancreatography in acute and chronic pancreatitis. J Clin Gastroenterol 34:560–568CrossRefPubMedGoogle Scholar
  24. 24.
    Schoelgens C (1998) Native tissue harmonic imaging. Radiologe 38:420–423CrossRefPubMedGoogle Scholar
  25. 25.
    Desser TS, Jeffrey RB (2001) Tissue harmonic imaging techniques: physical principles and clinical applications. Semin US CT MR 22:1–10Google Scholar
  26. 26.
    Averkiou MA, Hamilton MF (1997) Nonlinear distortion of short pulses radiated by plane and focused circular pistons. J Acoust Soc Am 102:2539–2548CrossRefPubMedGoogle Scholar
  27. 27.
    Christopher DA, Burns PN, Starkoski BG, Foster FS (1997) A high-frequency pulsed-wave Doppler US system for the detection and imaging of blood flow in the microcirculation. US Med Biol 23:997–1015CrossRefGoogle Scholar
  28. 28.
    Ward B, Baker AC, Humphrey VF (1997) Nonlinear propagation applied to the improvement of resolution in diagnostic medical US. J Acoust Soc Am 101:143–154PubMedGoogle Scholar
  29. 29.
    Duck FA (2002) Nonlinear acoustics in diagnostic US. US Med Biol 28:1–18CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Christian Hohl
    • 1
  • Thorsten Schmidt
    • 1
  • Patrick Haage
    • 1
  • Dagmar Honnef
    • 1
  • Marcus Blaum
    • 1
  • Gundula Staatz
    • 1
  • Rolf W. Guenther
    • 1
  1. 1.Department of Diagnostic RadiologyUniversity of Technology of AachenAachenGermany

Personalised recommendations