Imaging Features and Clinical Significance of Perineural Spread or Extension of Head and Neck Tumors

Karen S. Caldemeyer, Vincent Mathews, Paul D. Righi, Richard R. Smith

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Perineural spread of head and neck tumors is a form of metastatic disease in which tumor disseminates to noncontiguous regions along the endoneurium or perineurium. Both computed tomography (CT) and magnetic resonance (MR) imaging can help detect perineural spread, although MR imaging is the modality of choice because of its multiplanar capability, its superior soft-tissue contrast, and the decreased amount of artifact from dental hardware. Perineural spread most commonly occurs in adenoid cystic carcinoma and squamous cell carcinoma. Nerve enlargement may lead to foraminal enlargement and, ultimately, to foraminal destruction, findings that are best seen at CT. Extension through the foramen ovale and involvement of the Meckel cave is best seen on coronal T1-weighted MR images, and nerve enhancement is best seen on fatsuppressed T1-weighted MR images. Other radiologic findings include obliteration of fat planes at foraminal openings, neuropathic atrophy, cavernous sinus enlargement, and replacement of the trigeminal subarachnoid cistern with soft tissue. The pathway of perineural tumor spread is predictable with knowledge of the pertinent cranial nerve anatomy; however, patients with radiologically or pathologically proved perineural spread may have normal nerve function at clinical examination. Therefore, it is imperative that the radiologist be familiar with both normal cranial nerve anatomy and the radiologic appearance and assessment of perineural tumor extension.

Original languageEnglish
Pages (from-to)97-110
Number of pages14
JournalRadiographics
Volume18
Issue number1
StatePublished - Jan 1998

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Neck
Head
Cranial Nerves
Peripheral Nerves
Neoplasms
Anatomy
Magnetic Resonance Spectroscopy
Tomography
Magnetic Resonance Imaging
Foramen Ovale
Image Enhancement
Adenoid Cystic Carcinoma
Cavernous Sinus
Artifacts
Atrophy
Squamous Cell Carcinoma
Tooth
Fats

Keywords

  • Head and neck neoplasms, 20.37
  • Head and neck neoplasms, metastases, 20.375
  • Nerves, cranial, 154.375
  • Nervous system, neoplasms, 20.375

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Imaging Features and Clinical Significance of Perineural Spread or Extension of Head and Neck Tumors. / Caldemeyer, Karen S.; Mathews, Vincent; Righi, Paul D.; Smith, Richard R.

In: Radiographics, Vol. 18, No. 1, 01.1998, p. 97-110.

Research output: Contribution to journalArticle

Caldemeyer, Karen S. ; Mathews, Vincent ; Righi, Paul D. ; Smith, Richard R. / Imaging Features and Clinical Significance of Perineural Spread or Extension of Head and Neck Tumors. In: Radiographics. 1998 ; Vol. 18, No. 1. pp. 97-110.
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