"CADEAT": considerations on the use of CAD (computer-aided diagnosis) in mammography.

Computer-aided diagnosis (CAD) has been extensively reported to increase sensitivity by about 10% when added to a single reading while increasing recall rate by 12%, and its current use can be safely recommended in clinical practice. CAD has been suggested as a possible alternative to conventional double reading in screening. Uncontrolled comparison is consistent and suggests that CAD is comparable to double reading in incremental cancer detection rate (CAD +10.6%, double reading +9.1%) and possibly better in recall rate (CAD +12.5%, double reading +28.8%). However, controlled studies comparing single reading + CAD to conventional double reading are not consistent and on average suggest a lower cancer detection rate (-5.1%) and a lower recall rate (-9.8%) for CAD. Scientific evidence is not sufficient for a safe recommendation of single reading + CAD as a current alternative to conventional double reading.

Breast ultrasound and new technologies.

Technological advances are opening new fields of investigation for breast ultrasound. Specificity and color Doppler, staging and extended clinical roles in benign conditions are reviewed according to the state-of-the-art technology. Annular arrays are the best technical choice but new broadband linear arrays approach their quality and allow to visualize very slow flows within the breast. Still limitations exist and ultrasound is not suitable for screening. Providing better definition of normal as well as abnormal features, high-resolution sonography improves the specificity of the diagnosis for the majority of nodules and allows a better definition of both local and regional staging in nodular and diffuse conditions. Color Doppler and contrast media are increasing ultrasound specificity and are particularly useful in evaluating vascularity during therapies. Impressive results are achieved in the study of multifocal and multicentric carcinomas, in determining the degree of tumoral invasion of the surrounding tissues and of the ducts. Local and regional staging are greatly improved; the information given to the surgeon is more precise and allows easier therapeutic decisions. The diagnostic role of high-frequency ultrasound is also convincing in most benign conditions like inflammations, traumas and duct ectasia. In most of these conditions sonography is the best imaging modality to study the disease type and extent. The ability to monitor treatment efficacy or the natural outcome makes ultrasound and color Doppler a gold standard for breast inflammations.

High-resolution sonography of breast carcinoma.

The use of broad band transducers determined a great increase in spatial, contrast and vascular resolution of ultrasound probes dedicated to breast studies. Providing better definition of normal as well as pathologic features, high resolution sonography improves the specificity of the diagnosis for the majority of malignant nodules and allows a better definition of both local and regional staging. The most impressive results have been achieved in the evaluation of multifocal and multicentric carcinomas, in determining the size of the tumor, its degree of invasion of the surrounding tissues and of the ducts. Color and power Doppler offer further characterization that may be particularly useful in evaluating tumor vascularity during therapies that are planned before surgery. These new staging possibilities must push the radiologists to adequate their instruments and their methods to provide up-to-date and more accurate informations to the surgeon.

[Urography in the diagnosis of chronic renal insufficiency. II. The radiological pictures]. / L'apporto della urografia nella diagnostica della insufficienza renale cronica. II. I quadri radiologici.

Following a discussion of individual symptomatological findings, urographical patterns obtained in the various disease conditions capable of causing chronic renal failure are examined. A number of cases are presented by way of example.