Comparing Differential Tissue Harmonic Imaging With Tissue Harmonic and Fundamental Gray Scale Imaging of the Liver

Objective The purpose of this study was to compare fundamental gray scale sonography, tissue harmonic imaging (THI), and differential tissue harmonic imaging (DTHI) for depicting normal and abnormal livers. Methods The in vitro lateral resolution of DTHI, THI, and sonography was assessed in a phantom. Sagittal and transverse images of right and left hepatic lobes of 5 volunteers and 20 patients and images of 27 liver lesions were also acquired. Three independent blinded readers scored all randomized images for noise, detail resolution, image quality, and margin (for lesions) on a 7‐point scale. Next, images from the same location obtained with all 3 modes were compared blindly side by side and rated by all readers. Contrast‐to‐noise ratios were calculated for the lesions, and the depth of penetration (centimeters) was determined for all images. Results In vitro, the lateral resolution of DTHI was significantly better than fundamental sonography (P = .009) and showed a trend toward significance versus THI (P = .06). In the far field, DTHI performed better than both modes (P < .04). In vivo, 450 images were scored, and for all parameters, DTHI and THI did better than sonography (P < .002). Differential tissue harmonic imaging scored significantly higher than THI with regard to detail resolution and image quality (P < .001). The average increase in penetration with THI and DTHI was around 0.6 cm relative to sonography (P < .0001). The contrast‐to‐noise ratio for DTHI showed a trend toward significance versus THI (P = .06). Side‐by‐side comparisons rated DTHI better than THI and sonography in 54% of the cases (P < .007). Conclusions Tissue harmonic imaging and DTHI do better than fundamental sonography for hepatic imaging, with DTHI being rated the best of the 3 techniques.