Detection of cutaneous invasion by malignant head and neck tumors with MDCT.
OBJECTIVE
Cutaneous invasion by direct infiltration and metastasis, in malignant head and neck tumors, has a distinct impact on therapeutic options, especially surgical procedures, curative intent, and overall prognosis. Therefore, the purpose of this study was to determine the diagnostic accuracy of MDCT in detecting cutaneous invasion by malignant head and neck tumors.


METHODS
Nineteen patients with malignant head and neck tumors and clinical suspicion of cutaneous invasion routinely underwent contrast-enhanced 16-row MDCT (Philips MDCT MX 8000) of the region of interest in the axial plane before surgical intervention. The following parameters were used: 16mmx0.75mm detector collimation; 3mm reconstructed slice thickness; 1.5mm increment; 0.75s rotation speed; 120kV, 200mAs; and 100ml non-ionic contrast agent, i.v., with a flow of 2.0ml/s and a scan delay of 50s. The studies were reconstructed with a soft tissue algorithm (W400, L100 HU), and coronal and sagittal planes were also reconstructed. The axial images were retrospectively reviewed in consensus by two radiologists for the evidence of cutaneous invasion blinded to the histological results. The MDCT results were correlated with histology that was obtained by punch biopsy or surgery.


RESULTS
MDCT correctly revealed 11 of 11 cases with cutaneous invasion, and correctly excluded 4 of 8 cases without cutaneous invasion. The diagnostic accuracy of MDCT in detecting cutaneous invasion showed a sensitivity of 100%, a specificity of 50%, and an overall accuracy of 79%.


CONCLUSIONS
MDCT reconstructed with a soft tissue algorithm has a good sensitivity and moderate overall accuracy in detecting cutaneous invasion by malignant head and neck tumors.
Nemec
Stefan Franz
SF
Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. stefan.nemec@meduniwien.ac.at
Linecker
Alexander
A
Czerny
Christian
C
Imhof
Herwig
H
Krestan
Christian Robert
CR
D000328:Adult; D000368:Aged; D000465:Algorithms; D003287:Contrast Media; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging*; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary*; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media