Cardiopulmonary Long-Term Sequelae in Patients after Severe COVID-19 Disease.

We aimed to identify cardiopulmonary long-term effects after severe COVID-19 disease as well as predictors of Long-COVID in a prospective registry. A total of 150 consecutive, hospitalized patients (February 2020 and April 2021) were included six months post hospital discharge for a clinical follow-up. Among them, 49% experienced fatigue, 38% exertional dyspnea and 75% fulfilled criteria for Long-COVID. Echocardiography detected reduced global longitudinal strain (GLS) in 11% and diastolic dysfunction in 4%. Magnetic resonance imaging revealed traces of pericardial effusion in 18% and signs of former pericarditis or myocarditis in 4%. Pulmonary function was impaired in 11%. Chest computed tomography identified post-infectious residues in 22%. Whereas fatigue did not correlate with cardiopulmonary abnormalities, exertional dyspnea was associated with impaired pulmonary function (OR 3.6 [95% CI: 1.2-11], p = 0.026), reduced GLS (OR 5.2 [95% CI: 1.6-16.7], p = 0.003) and/or left ventricular diastolic dysfunction (OR 4.2 [95% CI: 1.03-17], p = 0.04). Predictors of Long-COVID included length of in-hospital stay (OR: 1.15 [95% CI: 1.05-1.26], p = 0.004), admission to intensive care unit (OR cannot be computed, p = 0.001) and higher NT-proBNP (OR: 1.5 [95% CI: 1.05-2.14], p = 0.026). Even 6 months after discharge, a majority fulfilled criteria for Long-COVID. While no associations between fatigue and cardiopulmonary abnormalities were found, exertional dyspnea correlated with impaired pulmonary function, reduced GLS and/or diastolic dysfunction.

Imaging of Metabolic Bone Diseases: The Spine View, Part I.

Metabolic bone diseases comprise a wide spectrum. Of them, osteoporosis is the most frequent and the most commonly found in the spine, with a high impact on health care systems and on morbidity due to vertebral fractures (VFs).This article discusses state-of-the-art techniques on the imaging of metabolic bone diseases in the spine, from the well-established methods to the latest improvements, recent developments, and future perspectives.We review the classical features of involvement of metabolic conditions involving the spine. Then we analyze the different imaging techniques for the diagnosis, characterization, and monitoring of metabolic bone disease: dual-energy X-ray absorptiometry (DXA) and DXA-based fracture risk assessment applications or indexes, such as the geometric parameters, Bone Strain Index, and Trabecular Bone Score; quantitative computed tomography; and magnetic resonance and ultrasonography-based techniques, such as radiofrequency echographic multi spectrometry. We also describe the current possibilities of imaging to guide the treatment of VFs secondary to metabolic bone disease.

Imaging of Metabolic Bone Diseases: The Spine View, Part II.

Metabolic bone diseases comprise a wide spectrum. Osteoporosis, the most frequent, characteristically involves the spine, with a high impact on health care systems and on the morbidity of patients due to the occurrence of vertebral fractures (VFs).Part II of this review completes an overview of state-of-the-art techniques on the imaging of metabolic bone diseases of the spine, focusing on specific populations and future perspectives. We address the relevance of diagnosis and current status on VF assessment and quantification. We also analyze the diagnostic techniques in the pediatric population and then review the assessment of body composition around the spine and its potential application. We conclude with a discussion of the future of osteoporosis screening, through opportunistic diagnosis and the application of artificial intelligence.

[Contrast media - Guidelines for practical use]. / Kontrastmittel ­ Handlungsempfehlungen für die Praxis.

Contrast agents have become an indispensable part of everyday life in diagnostic radiology. In multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), they provide essential diagnostic information, especially for vascular, inflammatory or oncologic diseases, which otherwise could not be answered. The two most important groups are iodine- and gadolinium-containing contrast agents. Rare side effects include PC-AKI (post-contrast acute kidney injury); more common are allergic and chemotoxic reactions. Since the introduction of guidelines, nephrogenic fibrosis has not been reported anymore, whereas gadolinium deposition in the central nervous system (CNS) has become a new topic. Concerning contrast media use in patients with reduced renal function, at a eGFR threshold of <45 ml/min or <30 ml/min, hydration and a review of indication for enhanced MDCT, depending on the application, is recommended. Low kV and DE-scan protocols with MDCT can help to reduce the amount of iodinated contrast agents. In MRI examinations, only macrocyclic contrast agents should be used for enhanced MRI exams. There has to be a careful risk-benefit analysis with enhanced studies in pregnancy, during lactation and in the pediatric population. Patient information and legal aspects with nonapproved indications are indispensable parts of daily clinical routine. The continuous updating and broadening of knowledge regarding the appropriate use of the various contrast agents has to be an integral part of clinical diagnostic radiology.

Imaging Following Fractures of and Around the Knee.

Related to fractures of and around the knee, inappropriate technical factors related to the surgery, severe comminution of the fracture, early overly arduous rehabilitation of the patient, and patient-related noncompliances may have the potential for the risk of inadequate fixation and other complications. Loss of fixation, malunion/nonunion, infection, arthritis, arthrofibrosis, and symptomatic hardware are among postsurgical complications that may necessitate further reconstructive techniques. In this review, complications that may be encountered in the postsurgical period of fractures involving the patella, supracondylar femur, and tibial plateau are described.

Displaced juvenile Tillaux fractures : Surgical treatment and outcome.

BACKGROUND: Approximately 15 % of all juvenile injuries of the long bones involve the epiphyseal growth plate, and 2.9 % of these are juvenile Tillaux fractures. The Tillaux fracture is of great importance because it involves a major weight-bearing articular surface. Treatment protocols in the literature are not uniform for this kind of fracture, and numerous case reports can be found describing various treatment methods. The aim of this study was to present the clinical outcome at long-term follow-up after treatment of displaced Tillaux fractures. METHODS: In all, 168 children and adolescent patients with physeal injuries of the distal tibia were treated from 2003 to 2012. Seven patients were identified as having Tillaux fractures requiring surgical treatment and therefore were included in our study and evaluated retrospectively. RESULTS: Seven patients with Tillaux fractures underwent surgical reconstruction by open or closed reduction. Excellent results were achieved in 90 % of the patients, with a mean Foot and Ankle Score at the last follow-up of 98.71. CONCLUSION: Anatomical reduction is required for every displaced epiphyseal fracture via open reduction and internal fixation, especially in cases with ≥2 mm fragment displacement. Plaster cast immobilization and non-weight-bearing mobilization for at least 4 weeks might be a good way of ensuring optimal surgical results and preventing complications.

Distinguishing Benign and Malignant Vertebral Fractures Using CT and MRI.

The differential diagnosis between benign and malignant vertebral fractures is a common challenge in clinical practice, especially because osteoporotic fractures become more frequent within the aging population and many malignant diseases spread to the bone first, impacting bone integrity. This article reviews the morphological features and computed tomography (CT) and magnetic resonance imaging (MRI) imaging findings that help differentiate between benign and malignant fractures. Newer techniques such as MR-based diffusion-weighted imaging, dynamic contrast-enhanced MR, and chemical-shift imaging as well as hybrid techniques such as positron emission tomography-CT are also discussed briefly.

Bisphosphonate and Medication-Related Osteonecrosis of the Jaw: A Review.

For patients with malignant disease taking bisphosphonates and denosumab, the incidence of medication-related osteonecrosis of the jaw (MRONJ) is up to 15% in contrast to 0.01% in patients with osteoporosis. Clinical presentation of MRONJ extends from asymptomatic exposure of bone in 94% of patients to severe cases of mandibular fractures in a minority of 4.5%. The strongest risk factors for MRONJ are invasive dental procedures and dental infections. Advances in imaging provide more preoperation information compared with panoramic radiograph. Prevention strategies are the elimination of potential risk factors leading to invasive dental procedures and maintenance of good oral hygiene prior to the administration of antiresorptive agents. Management of MRONJ depends on the underlying disease, extent of the necrosis, and the presence of contributing therapy. Conservative therapies include topical anti-infective rinses and systemic antibiotic therapy. The most important part of surgical therapy is to remove the exposed and necrotic bone. Several options for defect closure are possible from local tissue flaps to microvascular free flap procedures. The development of MRONJ in conjunction with dental implants is a severe side effect and should be avoided if potentially harmful medication has already been administered.

Soft Tissue Tumors in Adults: ESSR-Approved Guidelines for Diagnostic Imaging.

Soft tissue sarcomas are rare, but early, accurate diagnosis with subsequent appropriate treatment is crucial for the clinical outcome. The ESSR guidelines are intended to help radiologists in their decision-making and support discussion among clinicians who deal with patients with suspected or proven soft tissue tumors. Potentially malignant lesions recognized by ultrasound should be referred for magnetic resonance imaging (MRI), which also serves as a preoperative local staging modality, with specific technical requirements and mandatory radiological report elements. Radiography may add information about matrix calcification and osseous involvement. Indeterminate lesions, or lesions in which therapy is dependent on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist sarcoma center, where an interdisciplinary tumor group, with a specialized pathologist, radiologist, and the surgeon are involved. In sarcoma, a CT scan of the chest is mandatory. Additional staging modalities are entity-specific. There are no evidence-based recommendations for routine follow-up in surgically treated sarcomas. However, we would recommend regular follow-up with intervals dependent on tumor grade, for 10 years after the initial diagnosis.

Quantitative evaluation of contrast-enhanced ultrasound after intravenous administration of a microbubble contrast agent for differentiation of benign and malignant thyroid nodules: assessment of diagnostic accuracy.

OBJECTIVES: To investigate the diagnostic accuracy, through quantitative analysis, of contrast-enhanced ultrasound (CEUS), using a microbubble contrast agent, in the differentiation of thyroid nodules. METHODS: This prospective study enrolled 46 patients with solitary, scintigraphically non-functional thyroid nodules. These patients were scheduled for surgery and underwent preoperative CEUS with pulse-inversion harmonic imaging after intravenous microbubble contrast medium administration. Using histology as a standard of reference, time-intensity curves of benign and malignant nodules were compared by means of peak enhancement and wash-out enhancement relative to the baseline intensity using a mixed model ANOVA. ROC analysis was performed to assess the diagnostic accuracy in the differentiation of benign and malignant nodules on CEUS. RESULTS: The complete CEUS data of 42 patients (31/42 [73.8%] benign and 11/42 [26.2%] malignant nodules) revealed a significant difference (P < 0.001) in enhancement between benign and malignant nodules. Furthermore, based on ROC analysis, CEUS demonstrated sensitivity of 76.9%, specificity of 84.8% and accuracy of 82.6%. CONCLUSIONS: Quantitative analysis of CEUS using a microbubble contrast agent allows the differentiation of benign and malignant thyroid nodules and may potentially serve, in addition to grey-scale and Doppler ultrasound, as an adjunctive tool in the assessment of patients with thyroid nodules. KEY POINTS: • Contrast-enhanced ultrasound (CEUS) helps differentiate between benign and malignant thyroid nodules. • Quantitative CEUS analysis yields sensitivity of 76.9% and specificity of 84.8%. • CEUS may be a potentially useful adjunct in assessing thyroid nodules.

MRI versus radiography of acromioclavicular joint dislocation.

OBJECTIVE: Acromioclavicular joint injuries are usually diagnosed by clinical and radiographic assessment with the Rockwood classification, which is crucial for treatment planning. In view of the implementation of MRI for visualization of the acromioclavicular joint, the purpose of this study was to describe the MRI findings of acromioclavicular joint dislocation in comparison with the radiographic findings. SUBJECTS AND METHODS: Forty-four patients with suspected unilateral acromioclavicular joint dislocation after acute trauma were enrolled in this prospective study. All patients underwent digital radiography and 1-T MRI with a surface phased-array coil. MRI included coronal proton density-weighted turbo spin-echo and coronal 3D T1-weighted fast field-echo water-selective sequences. The Rockwood classification was used to assess acromioclavicular joint injuries at radiography and MRI. An adapted Rockwood classification was used for MRI evaluation of the acromioclavicular joint ligaments. The classifications of acromioclavicular joint dislocations diagnosed with radiography and MRI were compared. RESULTS: Among 44 patients with Rockwood type I-IV injuries on radiographs, classification on radiographs and MR images was concordant in 23 (52.2%) patients. At MRI, the injury was reclassified to a less severe type in 16 (36.4%) patients and to a more severe type in five (11.4%) patients. Compared with the findings according to the original Rockwood system, with the adapted system that included MRI findings, additional ligamentous lesions were found in 11 (25%) patients. CONCLUSION: In a considerable number of patients, the MRI findings change the Rockwood type determined with radiography. In addition to clinical assessment and radiography, MRI may yield important findings on ligaments that may influence management.

Bone microarchitecture in hemodialysis patients assessed by HR-pQCT.

BACKGROUND AND OBJECTIVES: Dialysis patients are at high risk for low-trauma bone fracture. Bone density measurements using dual-energy x-ray absorptiometry (DXA) do not reliably differentiate between patients with and without fractures. The aim of this study was to identify differences in bone microarchitecture between patients with and without a history of fracture using high-resolution peripheral quantitative computed tomography (HR-pQCT). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Seventy-four prevalent hemodialysis patients were recruited for measurements of areal bone mineral density (aBMD) by DXA and bone microarchitecture by HR-pQCT. Patients with a history of trauma-related fracture were excluded. Forty healthy volunteers served as controls. Blood levels of parathyroid hormone, vitamin D, and markers of bone turnover were determined. RESULTS: Dialysis patients, particularly women, had markedly impaired bone microarchitecture. Patients with fractures had significantly reduced cortical and trabecular microarchitecture compared with patients without fractures. aBMD tended to be lower in patients with fractures, but differences were statistically not significant. The strongest determinant of fracture was the HR-pQCT-measured trabecular density of the tibia, which also had the highest discriminatory power to differentiate patients according to fracture status. Radial DXA had a lower discriminatory power than trabecular density. CONCLUSIONS: Bone microarchitecture is severely impaired in dialysis patients and even more so in patients with a history of fracture. HR-pQCT can identify dialysis patients with a history of low-trauma fracture.

Imaging of insufficiency fractures.

This review article focuses on occurrence, imaging, and differential diagnosis of insufficiency fractures. Prevalence and the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures are due to normal stress exerted on weakened bone. Most commonly postmenopausal osteoporosis is the cause for insufficiency fractures. Additional conditions affecting bone turnover include osteomalacia, chronic renal failure, and high-dose corticosteroid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures as well as to differentiate them from malignant fractures. Radiographs are the basic modality used for screening of insufficiency fractures, yet depending on the location of the fractures, sensitivity is limited. Magnetic resonance imaging is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures and allows differentiation of benign versus malignant fractures. Thin section multidetector computed tomography (CT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Dedicated Mikro-CTs (Xtreme-CT) can detect subtle fractures reaching an in-plane resolution of 80 µm. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but unsatisfactory specificity. Positron emission tomography-CT with hybrid-scanners has been the upcoming modality for the differentiation of benign from malignant fractures. Bone densitometry and clinical fracture history may determine the future risk of possible insufficiency fractures.

Abnormalities of the penis in utero--hypospadias on fetal MRI.

OBJECTIVE: To demonstrate the visualization of penile abnormalities on fetal magnetic resonance imaging (MRI). METHODS: This retrospective study included five fetuses (25+0 to 31+6 gestational weeks) with penile abnormalities, positively depicted on fetal MRI, using prenatal ultrasonography (US) as a standard of reference. On MRI, the penis, as well as the scrotum and testicles, were evaluated. All fetal organs were reviewed to define penile abnormalities as isolated or in association with other anomalies. Furthermore, US and MRI findings were compared. RESULTS: Posterior hypospadias were demonstrated in all five fetuses, and abnormal testicular descent in two. Associated anomalies were present in all five fetuses on MRI, including abdominal/urogenital pathologies in four; brain pathologies in three; and craniofacial, cardiac, musculoskeletal, pathologies each in one fetus, and intrauterine growth retardation in one fetus. Compared to US, additional MRI findings were shown in four of five fetuses. CONCLUSIONS: Our MRI results demonstrate the visualization of fetal penile abnormalities and associated pathologies, which may provide information for perinatal management. MRI may show additional findings compared to prenatal US in certain cases.

CT-MR image data fusion for computer-assisted navigated surgery of orbital tumors.

PURPOSE: To demonstrate the value of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative assessment of orbital tumors, and to present, particularly, CT and MR image data fusion for surgical planning and performance in computer-assisted navigated surgery of orbital tumors. MATERIALS AND METHODS: In this retrospective case series, 10 patients with orbital tumors and associated complaints underwent MDCT and MRI of the orbit. MDCT was performed at high resolution, with a bone window level setting in the axial plane. MRI was performed with an axial 3D T1-weighted (w) gradient-echo (GE) contrast-enhanced sequence, in addition to a standard MRI protocol. First, MDCT and MR images were used to diagnose tumorous lesions compared to histology as a standard of reference. Then, the image data sets from CT and 3D T1-w GE sequences were merged on a workstation to create CT-MR fusion images that were used for interventional planning and intraoperative image guidance. The intraoperative accuracy of the navigation unit was measured, defined as the deviation between the same landmark in the navigation image and the patient. Furthermore, the clinical preoperative status was compared to the patients' postoperative outcome. RESULTS: Radiological and histological diagnosis, which revealed 7 benign and 3 malignant tumors, were concordant in 7 of 10 cases (70%). The CT-MR fusion images supported the surgeon in the preoperative planning and improved the surgical performance. The mean intraoperative accuracy of the navigation unit was 1.35mm. Postoperatively, orbital complaints showed complete regression in 6 cases, were ameliorated notably in 3 cases, and remained unchanged in 1 case. CONCLUSION: CT and MRI are essential for the preoperative assessment of orbital tumors. CT-MR image data fusion is an accurate tool for planning the correct surgical procedure, and can improve surgical results in computer-assisted navigated surgery of orbital tumors.

Imaging of insufficiency fractures.

This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

Sinonasal imaging after Caldwell-Luc surgery: MDCT findings of an abandoned procedure in times of functional endoscopic sinus surgery.

BACKGROUND AND PURPOSE: Today, functional endoscopic sinus surgery (FESS) is performed in most of the patients with sinonasal inflammatory disease. The postoperative imaging findings of FESS in multidetector computed tomography (MDCT) considerably differ from those of historic Caldwell-Luc (CL) maxillary sinus surgery which is an uncommon procedure today. Thus, the postoperative CL imaging findings may lead to diagnostic confusion and misinterpretation. Therefore, this study explicitly presents the MDCT findings of post-CL patients which have not been described previously. METHODS: Twenty-eight patients with clinically suspected sinusitis and documented history of CL-procedure underwent 16 row MDCT (MDCT Mx8000 IDT Philips) with multiplanar reconstructions of the paranasal sinuses in the axial plane. The following parameters were used: 140kV, 50mAs; 16mmx0.75mm detector collimation; 1mm reconstructed slice thickness; 0.5mm increment. The studies were reconstructed with a bone algorithm (W3000/L600; 1mm slice thickness) in axial plane and coronal plane (3mm slice thickness). The images were retrospectively evaluated for the presence of normal surgery-related and pathological findings. RESULTS: Surgery-related imaging characteristics presented as follows: an anterior and a medial bony wall defect and sclerosis and sinus wall thickening were observed in all 28/28 cases (100%). Collaps of the sinus cavity was seen in 26/28 cases (92.9%). Furthermore, inflammatory disease of the operated sinus(es) was found in 23/28 cases (82.1%): 14/28 patients (50%) had inflammatory mucosal thickening of the operated sinus(es) as well as of other sinonasal cavities and 9/28 patients (32.1%) had inflammatory mucosal thickening limited to the operated sinus(es). A postoperative mucocele was depicted in 3/28 cases (10.7%). 2/28 patients (7.1%) showed neither maxillary nor other mucosal swelling. CONCLUSION: MDCT with multiplanar reconstructions is a precise method to evaluate post-CL patients and helps to differentiate normal surgery-related findings, which may mimic pathology, from real pathological findings.

High-resolution magnetic resonance imaging and conventional magnetic resonance imaging on a standard field-strength magnetic resonance system compared to arthroscopy in patients with suspected meniscal tears.

RATIONALE AND OBJECTIVES: We sought to evaluate the diagnostic performance of high-resolution magnetic resonance imaging (MRI) and conventional MRI of the knee on a standard-field-strength MRI system compared to arthroscopic findings in patients with suspected meniscal tears. MATERIALS AND METHODS: Forty-two patients (20 women, 22 men), referred from the department of trauma surgery, with suspected medial meniscal tears and planned arthroscopy of the knee joint were included in the study. MRI was performed on a 1.0-T MRI scanner with two different protocols: (1) conventional MRI using a circular, polarized knee coil (coil diameter: 17 cm) with a sagittal dual fast spin-echo sequence (repetition time [TR]: 2500 ms; echo time [TE]: first, shortest, second, 120 ms; turbo spin echo [TSE] factor: 12; field of view: 180 mm; matrix: 256 x 512; scan percentage: 100; slice thickness: 3 mm) or (2) high-resolution MRI with a surface dual-loop coil of the medial knee compartment (temporomandibular joint, coil diameter: 8 cm) with a sagittal dual fast spin-echo sequence (TR: 2400 ms; TE: first, shortest; second, 120 ms; TSE factor: 12; field of view: 120 mm; matrix: 512 x 512; slice thickness: 2 mm). The menisci were evaluated on the basis of an adapted score (0 = normal meniscus, 1 = intrameniscal, T2-weighted hyperintense signal, 2 = discontinuity of the surface, 3 = fragmentation). Lesions that received a score of 2 or 3 were graded as meniscal tears. The MRI results were compared to the arthroscopic reports, which represented the gold standard, and the sensitivity of both protocols in detecting a meniscal tear was determined. RESULTS: Of the 42 patients included in the study, 25 (11 women and 14 men) underwent arthroscopy and all demonstrated a meniscal tear. A meniscal tear was correctly diagnosed in 76% of cases with conventional MRI and in 88% of cases with high-resolution MRI (P = .0087). CONCLUSION: High-resolution MRI, using a surface dual-loop coil and specific sequences, which can be performed on every standard-field-strength MRI scanner, is able to significantly improve diagnostic performance for the detection of a meniscal tear of the knee joint.

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. MATERIALS AND 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%. CONCLUSION: 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.