Tissue Harmonic Imaging of the Breast

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Tissue harmonic imaging (THI):
    • Creates images derived solely from higher frequencies
  • The ultrasound beam:
    • Is transmitted centered at 1 frequency, e.g., 6 MHz, and received centered at a multiple of the transmitted frequency, e.g., 12 MHz
  • Different techniques can be used to process the received signals so that only the returning high-frequency harmonic signal is used to produce the image:
    • Whereas echoes from the fundamental / lower frequencies are rejected
  • THI increases signal-to-noise ratio:
    • Resulting in better tissue contrast
  • THI:
    • Reduces reverberation, clutter, and speckle artifacts:
      • Improving contrast resolution
    • It accentuates real echoes in addition to suppressing artifactual echoes
    • The suppression of speckle artifact by coded harmonics makes solid nodules more hypoechoic and conspicuous than they are with fundamental imaging (Images)
    • It makes the thin, echogenic capsule that surrounds most benign lesions appear to be thinner, more echogenic and more complete than with fundamental imaging
  • THI cannot be combined with simultaneous color Doppler imaging because the resulting frame rate would be unacceptable:
    • When Doppler is required, the image that is interlaced with Doppler must be constructed at fundamental rather than harmonic frequencies
  • THI is of limited value in differentiating benign from malignant lesions
  • Another method of reducing artifactual echoes, improving contrast, and making the thin, echogenic capsule more conspicuous is real time spatial compounding of images
  • In conventional imaging, each frame is created by a single sweep of the beam at a 90 degree angle to the long axis of the transducer:
    • In compound imaging, there are multiple sweeps of the beam from different angles, creating a spatially and temporally compounded image from multiple angles over time
    • Among other things, the lateral borders of lesions can be seen better with compound imaging
Infiltrating ductal carcinoma with fundamental imaging.
The same infiltrating ductal carcinoma as above with coded harmonic imaging
  • References:
    • Mesurolle B, Helou T, El-Khoury M, Edwardes M, Sutton EJ, Kao E. Tissue harmonic imaging, frequency compound imaging, and conventional imaging use and benefit in breast sonography. J Ultrasound Med. 2007;26(8):1041-1051.
    • Cha JH, Moon WK, Cho N, Kim SM, Park SH, Han BK, et al. Characterization of benign and malignant solid breast masses: comparison of conventional US and tissue harmonic imaging. Radiology. 2007;242(1):63-69.
    • Stavros AT. Breast ultrasound equipment requirements. In: Stavros AT. Breast Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:16-41.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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