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For a lesion diameter below 10 mm US accuracy is greatly reduced, reaching approx. 20%. Other elements contributing to lower US performance are: excessive obesity, fatty liver disease, hypomobility of the diaphragm, and certain patterns of hyperechoic or isoechoic metastases that can be overlooked or can mimic benign conditions.
Tissues that have higher echogenicity are called "hyperechoic" and are usually represented with lighter colors on images in medical ultrasonography. In contrast, tissues with lower echogenicity are called "hypoechoic" and are usually represented with darker colors.
The kidney is surrounded by a capsule separating the kidney from the echogenic perirenal fat, which is seen as a thin linear structure. [1] The kidney is divided into parenchyma and renal sinus. The renal sinus is hyperechoic and is composed of calyces, the renal pelvis, fat and the major intrarenal vessels.
Most of the cases occur in combination with other cell types. At ultrasound, embryonal cell carcinomas are predominantly hypoechoic lesions with ill-defined margins and an inhomogeneous echotexture. Echogenic foci due to hemorrhage, calcification, or fibrosis are commonly seen. Twenty percent of embryonal cell carcinomas have cystic components.
Features of benign lesion are: hyperechoic, having coarse, dysmorphic or curvilinear calcifications, comet tail artifact (reflection of a highly calcified object), absence of blood flow in the nodule, and presence of cystic (fluid-filled) nodule. However, the presence of solitary or multiple nodules is not a good predictor of malignancy.
Angiomyolipoma seen as a hyperechoic mass in the upper pole of an adult kidney on renal ultrasonography. Renal ultrasonography of a person with tuberous sclerosis and multiple angiomyolipomas in the kidney: Measurement of kidney length on the US image is illustrated by '+' and a dashed line. CT scan of a renal angiomyolipoma.
Medical ultrasonography of a lipoma in the thenar eminence: It is hyperechoic compared to adjacent muscle, and relatively well-defined, with miniature hyperechoic lines. [ 23 ] T1 MRI of the same lipoma: High intensity signal mass with regions of ill-defined margins [ 23 ]
Echogenic – giving rise to reflections (echoes) of ultrasound waves; Hyperechoic – more echogenic (brighter) than normal; Hypoechoic – less echogenic (darker) than normal; Isoechoic – the same echogenicity as another tissue; Transvaginal ultrasonography – Ultrasound is performed through the vagina