Imaging of perineural tumor spread in head and neck cancer

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Abstract

Perineural spread (PNS) of head and neck tumors is a well-described phenomenon whereby a lesion can migrate away from the primary site along the neural sheath. By this mechanism, tumor can spread a considerable distance and compromise vital neurologic structures, with significant impact on treatment and prognosis. It is crucial that radiologists search for PNS whenever imaging the head and neck cancer patient. Detection of PNS requires familiarity with common tumor types and locations that can give rise to it, an understanding of the relevant cranial nerve anatomy, and an awareness of the radiologic appearance and techniques best suited to imaging this important and often overlooked complication of head and neck cancer.

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    Citation Excerpt :

    On T1-weighted MRI, fat is generally present, and is normally hyperintense just after a nerve exits a foramen and in the pterygopalatine fossa. Obliteration of these fat pads is a key element in detecting macroscopic PNI [11,24]. Direct evidence of macroscopic PNI spread on MRI would be enlargement and enhancement along the course of a cranial nerve on post contrast T1-weighted images (Figs. 3, 4 and 5).

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