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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.

Purpose: To evaluate if Pulse Inversion Harmonic Imaging with contrast agent injection (Levovist) is able to determine an increase of echogenicity in normal hepatic parenchyma, and to compare its capability to detect metastatic focal lesions with that of standard US and spiral CT. To define and standardize the technical and methodological aspects of this new technique., Material and Methods: A selected group of 72 patients (42 males and 30 females) with clinical and instrumental suspect of hepatic metastatic lesions was included in the prospective study. Each patient was examined by conventional ultrasound (US), Pulse Inversion Harmonic Imaging (PI) and spiral-CT (spCT). US examination was performed using an HDI 5000 (ATL, Bothell, USA) equipped with a broadband probe (5.0-2.0 MHz). 2.5 g Levovist (Schering AG-Berlin) was administered intravenously, at concentration of 300 mg/ml and a flow rate of 7 ml/min. Video clips obtained with the acquired images before and after contrast medium administration were transferred to a magnet optic disk unit. Examinations were evaluated by an experienced radiologist blindly on a workstation that allowed a qualitative-quantitative analysis. SpCT images were evaluated separately by another experienced radiologist. US images were evaluated qualitatively (number of lesions, site of lesion, diameter of the smallest lesion detectable) and quantitatively (increase in parenchymal echogenicity 20", 40", 60" and 5' after the injection of contrast agent)., Results: In all cases examined, the echogenicity of normal hepatic parenchyma increased after contrast agent administration, reaching a peak of about 250% (1DS) at 60 s and a decreasing gradually in 5 minutes. Conventional US detected 195 focal lesions, CT 231, and US with pulse inversion technique and contrast agent (US-PI) 287. Mean differences among the number of lesions detected by the different techniques per each patient were also calculated. Wilcoxon Signed Rank Test showed a statistically significant difference between US-PI and US (p < .0001), CT and US (p = .0052) and US-PI and CT (p = .0121). US-PI detected the smallest lesions, which went undetected by the CT and conventional US examinations., Discussion and Conclusions: In 10 cases (14.3%) contrast enhanced US-PI demonstrated the presence of a number of lesions greater than 5 (diffuse metastatization and inoperability) in comparison to that detected by spCT). The greater echogenicity of normal hepatic parenchyma using pulse inversion technique after Levovist infusion allowed to better demonstrate hepatic metastases. This technique showed a higher identification rate of small lesions in comparison to basal examination and to spiral CT. Contrast enhanced US-PI demonstrated a remarkable increase in echogenicity of hepatic parenchyma in portal phase. The technique significantly improves the detection of focal lesions allowing visualization of smaller lesions compared to CT and US. These results indicate that the technique could be used in the staging of liver metastasis. However, large multicentric trials are required to validate US-PI and better define its role in the work-up of patients with neoplastic disorder.

Hormone replacement therapy (HRT) in post-menopausal or ovariectomized women reduces mortality due to cardiovascular diseases, lowers morbidity due to osteoporosis and improves vasovagal symptoms. Long-term therapy, however, increase the risk of side-effects. HRT may decrease mammographic sensitivity, markedly increasing glandular density. Enlargement of pre-existing cysts and fibroadenomas has also been reported after HRT. The correlation between HRT and breast cancer is highly controversial. We examined 650 women: 550 of them (84.6%) received HRT (157 estrogens and 393 estrogens-progestins) and 100 (15.4%) refused treatment and were thus considered as a control group. All patients underwent mammography and DEXA before HRT and, during treatment, were followed-up yearly with mammography, often combined with US, and DEXA. Fisher's test was used for data analysis (confidence interval: 95%). The statistical analysis showed a significant difference between the HRT group and the control group only for the lumbar spine. Mammographic changes (Tab. II) were shown in 150 of 550 HRT patients. Increased breast density was the most frequent finding. Benign lesions arising de novo or increasing in size and/or number were observed in 41 of 150 patients (27.3%) in the HRT group, where 3 breast carcinomas were detected, versus 1 breast cancer only in the control group. HRT had a marked positive effect on bone mineral content (BMC) at 2 years' follow-up, but it remains debated if it reduces breast cancer risk. In conclusion, our results indicate that a yearly mammography is mandatory in long-term HRT subjects and US may be also needed in particularly dense breasts.

The authors discuss the results from a series of 45 patients with breast lumps. All patients were studied by means of mammography, sonography, color Doppler US, and biopsy. Abnormal Doppler signal was observed in 94% of the patients with breast cancer. However, this finding is not specific because it can be occasionally found in benign lesions too. The use of color Doppler US is suggested in those cases where neither US nor mammography is conclusive.

Two different instruments for nonpalpable breast lesion localization, with different patient position (prone and sitting), were evaluated in precision performances by measuring the mean needle deviation on X and Y axes in 150 and 100 examinations, respectively. Both instruments yielded precise information: some drawbacks were observed with the stereotaxic instrument fitted to the plain mammographic unit, due to imperfect fixation in the sitting position of the patient. The development of special seats could obviate the problem, thus allowing a further improvement in the performance of this kind of instruments.

The role of sonography is evaluated in the diagnosis of ovarian tumors. Real-time US proves more sensitive than gynecological examination in the diagnosis of ovarian diseases. As yet, however, no correlation has been found between histological findings and US appearance. An accurate review of the relative literature and of our results lead us to the conclusion that sonography does not significantly affect the early diagnosis of ovarian tumors.

The radiological aspects of non-neoplastic renal expansive processes are reviewed and discussed, particular attention being paid to indications for the various investigation techniques and differential diagnosis. Numerous examples are reported.

Lumbar epidural venography was used as the examination of choice in the investigation of suspected disc herniation in 270 patients. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. In 110 patients operated on, the reliability of lumbar epidural venography was equal to 97.2%.

This article describes the normal radiological anatomy of the epidural veins whose understanding is necessary for the correct interpretation of venographic studies. Three ways of achieving adequate visualization of the epidural venous plexus are described. Experience with 80 cases is reported; a comparison has been made among the degree of visualization of the epidural venous plexus, the length of time, the cost and the amount of radiation received by the operator and patients during the performance of each technique. Preference is expressed for simultaneous injection of contrast media via two needles introduced into right and left femoral veins.

In 50 patients subjected to aorto-femoral arteriography, the examination was carried out with and without the addition of 1 cm3 of 2% lidocaine per 10 cm3 of contrast medium; in 43/50 lidocaine led to a more or less notable reduction in pain without side-effects.

The authors report the results of a multicentric experience based on 1200 urograms performed with nonionic contrast medium. The global diagnostic reliability is evaluated, together with the specific reliability for kidneys, ureters, and bladder, according to the various pathologies. The eventual need of radiographs of completion is showed. In searching for an optimization of the technique for nonionic contrast medium, a panoramic radiograph performed 10' after the end of the injection is pointed out as the key-moment of the test, being extremely rich in information, so as to help defining the most appropriate technique to continue the examination. For its excellent tolerability and high reliability, the nonionic contrast medium is recommended also in routine IVP, not only in risk patients.

Radiological methods useful in the examination of bladder tumours are reviewed, with particular reference to preoperative evaluation in accordance with the system. Examples are drawn from a personal series.

Embolization of very vascular intracranial meningiomas prior to operation will reduce the loss of blood during the operation. The indications and the technique of preoperative embolization are discussed and 20 cases are presented.

A case of cholangiocarcinoma observed in a woman of 38 following carotidographic examination with Thorotrast is described: the presence of radioactivity was also demonstrated by gamma spectrometry. The high mean dose absorbed by the liver (estimated at about 3,000 rad) together with the high relative biological effectiveness of the alpha contribution and the time lapse justify the hypothesis that the neoplasia was caused by irradiation.

The CT is an important and valuable instrument in the study of the postoperative lumbar spine, in the patients which presented persistent clinical manifestation. In this report the technique with contrast enhancement is outlined, the criteria for its interpretations are presented, and its advantages and limitations are reviewed; pitfalls in technique interpretation are stressed. Two hundred and fifty patients are referred to the CT without and with i.v. contrast medium for this diagnostic request: scar or herniation at surgery level.

Selective arteriography of the carotid and vertebral arteries by the femoral route was carried out in 225 cases. The technique, results, indications and contraindications are reported and discussed together with complications.