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Perineural Tumor Spread
Hilda E. Stambuk, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Perineural tumor spread (PNT)
            • Definitions

              • Malignant tumor spread along sheath of large nerves distant from 1° site
                • Epineurium & perineurium involved more than endoneurium

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          • Reporting Tips

                                            Selected References

                                            1. Bakst RL et al: Mechanisms of perineural invasion. J Neurol Surg B Skull Base. 77(2):96-106, 2016
                                            2. Brown IS: Pathology of perineural spread. J Neurol Surg B Skull Base. 77(2):124-30, 2016
                                            3. Deborde S et al: Schwann cells induce cancer cell dispersion and invasion. J Clin Invest. 126(4):1538-54, 2016
                                            4. Stambuk HE: Perineural tumor spread involving the central skull base region. Semin Ultrasound CT MR. 34(5):445-58, 2013
                                            5. Gandhi MR et al: Detecting and defining the anatomic extent of large nerve perineural spread of malignancy: comparing "targeted" MRI with the histologic findings following surgery. Head Neck. 33(4):469-75, 2011
                                            6. Grimm AR et al: Perineural spread to the cavernous sinus from cutaneous SCCa. Laryngoscope. 120 Suppl 4:S150, 2010
                                            7. Ong CK et al: Imaging of perineural spread in head and neck tumours. Cancer Imaging. 10 Spec no A:S92-8, 2010
                                            8. Ma J et al: Improving fat-suppressed T2-weighted imaging of the head and neck with 2 fast spin-echo dixon techniques: initial experiences. AJNR Am J Neuroradiol. 30(1):42-5, 2009
                                            9. Raghavan P et al: Imaging of the facial nerve. Neuroimaging Clin N Am. 19(3):407-25, 2009
                                            10. Warden KF et al: Perineural spread of cancer along the three trigeminal divisions. J Neuroophthalmol. 29(4):300-7, 2009
                                            11. Lee KJ et al: Determination of perineural invasion preoperatively on radiographic images. Otolaryngol Head Neck Surg. 139(2):275-80, 2008
                                            12. Lee TJ et al: Perineural spread of melanoma demonstrated by F-18 FDG PET With MRI and pathologic correlation. Clin Nucl Med. 33(2):106-8, 2008
                                            13. Lee YY et al: Imaging of salivary gland tumours. Eur J Radiol. 66(3):419-36, 2008
                                            14. Maroldi R et al: Perineural tumor spread. Neuroimaging Clin N Am. 18(2):413-29, xi, 2008
                                            15. Nakahara T et al: Detection of perineural tumor invasion of the head and neck: clinical use of thallium-201 SPECT/CT image fusion. Clin Nucl Med. 33(8):567-70, 2008
                                            16. Hanna E et al: The sensitivity and specificity of high-resolution imaging in evaluating perineural spread of adenoid cystic carcinoma to the skull base. Arch Otolaryngol Head Neck Surg. 133(6):541-5, 2007
                                            17. Ibrahim M et al: Imaging nuances of perineural spread of head and neck malignancies. J Neuroophthalmol. 27(2):129-37, 2007
                                            18. Mendenhall WM et al: Skin cancer of the head and neck with perineural invasion. Am J Clin Oncol. 30(1):93-6, 2007
                                            19. Nemec SF et al: Perineural tumor spread in malignant head and neck tumors. Top Magn Reson Imaging. 18(6):467-71, 2007
                                            20. Raghavan P et al: Magnetic resonance imaging of sinonasal malignancies. Top Magn Reson Imaging. 18(4):259-67, 2007
                                            21. VandeVyver V et al: MRI findings of the normal and diseased trigeminal nerve ganglion and branches: a pictorial review. JBR-BTR. 90(4):272-7, 2007
                                            22. Zima AJ et al: Magnetic resonance imaging of oropharyngeal cancer. Top Magn Reson Imaging. 18(4):237-42, 2007
                                            23. Nogajski JH et al: Perineural spread of facial squamous cell carcinoma. J Clin Neurosci. 13(3):400-3, 2006
                                            24. Yousem DM et al: Resectability issues with head and neck cancer. AJNR Am J Neuroradiol. 27(10):2024-36, 2006
                                            25. Chang PC et al: Perineural spread of malignant melanoma of the head and neck: clinical and imaging features. AJNR Am J Neuroradiol. 25(1):5-11, 2004
                                            26. Chong V: Imaging the cranial nerves in cancer. Cancer Imaging. 4 Spec No A:S1-5, 2004
                                            27. Curtin HD: Detection of perineural spread: fat suppression versus no fat suppression. AJNR Am J Neuroradiol. 25(1):1-3, 2004
                                            28. Gandhi D et al: Magnetic resonance imaging of perineural spread of head and neck malignancies. Top Magn Reson Imaging. 15(2):79-85, 2004
                                            29. Ginsberg LE: MR imaging of perineural tumor spread. Magn Reson Imaging Clin N Am. 10(3):511-25, vi, 2002
                                            30. Mendenhall WM et al: Carcinoma of the skin of the head and neck with perineural invasion. Head Neck. 24(1):78-83, 2002
                                            31. Schmalfuss IM et al: Perineural tumor spread along the auriculotemporal nerve. AJNR Am J Neuroradiol. 23(2):303-11, 2002
                                            32. Williams LS et al: Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis. Int J Radiat Oncol Biol Phys. 49(4):1061-9, 2001
                                            33. Boerman RH et al: Trigeminal neuropathy secondary to perineural invasion of head and neck carcinomas. Neurology. 53(1):213-6, 1999
                                            34. Ginsberg LE: Imaging of perineural tumor spread in head and neck cancer. Semin Ultrasound CT MR. 20(3):175-86, 1999
                                            35. Caldemeyer KS et al: Imaging features and clinical significance of perineural spread or extension of head and neck tumors. Radiographics. 18(1):97-110; quiz 147, 1998
                                            36. Curtin HD: Detection of perineural spread: fat is a friend. AJNR Am J Neuroradiol. 19(8):1385-6, 1998
                                            37. Ginsberg LE et al: Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread. AJNR Am J Neuroradiol. 17(2):389-93, 1996
                                            38. Parker GD et al: Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics. 11(3):383-99, 1991
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Perineural tumor spread (PNT)
                                                      • Definitions

                                                        • Malignant tumor spread along sheath of large nerves distant from 1° site
                                                          • Epineurium & perineurium involved more than endoneurium

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  • Image Interpretation Pearls

                                                                                    • Reporting Tips

                                                                                      Selected References

                                                                                      1. Bakst RL et al: Mechanisms of perineural invasion. J Neurol Surg B Skull Base. 77(2):96-106, 2016
                                                                                      2. Brown IS: Pathology of perineural spread. J Neurol Surg B Skull Base. 77(2):124-30, 2016
                                                                                      3. Deborde S et al: Schwann cells induce cancer cell dispersion and invasion. J Clin Invest. 126(4):1538-54, 2016
                                                                                      4. Stambuk HE: Perineural tumor spread involving the central skull base region. Semin Ultrasound CT MR. 34(5):445-58, 2013
                                                                                      5. Gandhi MR et al: Detecting and defining the anatomic extent of large nerve perineural spread of malignancy: comparing "targeted" MRI with the histologic findings following surgery. Head Neck. 33(4):469-75, 2011
                                                                                      6. Grimm AR et al: Perineural spread to the cavernous sinus from cutaneous SCCa. Laryngoscope. 120 Suppl 4:S150, 2010
                                                                                      7. Ong CK et al: Imaging of perineural spread in head and neck tumours. Cancer Imaging. 10 Spec no A:S92-8, 2010
                                                                                      8. Ma J et al: Improving fat-suppressed T2-weighted imaging of the head and neck with 2 fast spin-echo dixon techniques: initial experiences. AJNR Am J Neuroradiol. 30(1):42-5, 2009
                                                                                      9. Raghavan P et al: Imaging of the facial nerve. Neuroimaging Clin N Am. 19(3):407-25, 2009
                                                                                      10. Warden KF et al: Perineural spread of cancer along the three trigeminal divisions. J Neuroophthalmol. 29(4):300-7, 2009
                                                                                      11. Lee KJ et al: Determination of perineural invasion preoperatively on radiographic images. Otolaryngol Head Neck Surg. 139(2):275-80, 2008
                                                                                      12. Lee TJ et al: Perineural spread of melanoma demonstrated by F-18 FDG PET With MRI and pathologic correlation. Clin Nucl Med. 33(2):106-8, 2008
                                                                                      13. Lee YY et al: Imaging of salivary gland tumours. Eur J Radiol. 66(3):419-36, 2008
                                                                                      14. Maroldi R et al: Perineural tumor spread. Neuroimaging Clin N Am. 18(2):413-29, xi, 2008
                                                                                      15. Nakahara T et al: Detection of perineural tumor invasion of the head and neck: clinical use of thallium-201 SPECT/CT image fusion. Clin Nucl Med. 33(8):567-70, 2008
                                                                                      16. Hanna E et al: The sensitivity and specificity of high-resolution imaging in evaluating perineural spread of adenoid cystic carcinoma to the skull base. Arch Otolaryngol Head Neck Surg. 133(6):541-5, 2007
                                                                                      17. Ibrahim M et al: Imaging nuances of perineural spread of head and neck malignancies. J Neuroophthalmol. 27(2):129-37, 2007
                                                                                      18. Mendenhall WM et al: Skin cancer of the head and neck with perineural invasion. Am J Clin Oncol. 30(1):93-6, 2007
                                                                                      19. Nemec SF et al: Perineural tumor spread in malignant head and neck tumors. Top Magn Reson Imaging. 18(6):467-71, 2007
                                                                                      20. Raghavan P et al: Magnetic resonance imaging of sinonasal malignancies. Top Magn Reson Imaging. 18(4):259-67, 2007
                                                                                      21. VandeVyver V et al: MRI findings of the normal and diseased trigeminal nerve ganglion and branches: a pictorial review. JBR-BTR. 90(4):272-7, 2007
                                                                                      22. Zima AJ et al: Magnetic resonance imaging of oropharyngeal cancer. Top Magn Reson Imaging. 18(4):237-42, 2007
                                                                                      23. Nogajski JH et al: Perineural spread of facial squamous cell carcinoma. J Clin Neurosci. 13(3):400-3, 2006
                                                                                      24. Yousem DM et al: Resectability issues with head and neck cancer. AJNR Am J Neuroradiol. 27(10):2024-36, 2006
                                                                                      25. Chang PC et al: Perineural spread of malignant melanoma of the head and neck: clinical and imaging features. AJNR Am J Neuroradiol. 25(1):5-11, 2004
                                                                                      26. Chong V: Imaging the cranial nerves in cancer. Cancer Imaging. 4 Spec No A:S1-5, 2004
                                                                                      27. Curtin HD: Detection of perineural spread: fat suppression versus no fat suppression. AJNR Am J Neuroradiol. 25(1):1-3, 2004
                                                                                      28. Gandhi D et al: Magnetic resonance imaging of perineural spread of head and neck malignancies. Top Magn Reson Imaging. 15(2):79-85, 2004
                                                                                      29. Ginsberg LE: MR imaging of perineural tumor spread. Magn Reson Imaging Clin N Am. 10(3):511-25, vi, 2002
                                                                                      30. Mendenhall WM et al: Carcinoma of the skin of the head and neck with perineural invasion. Head Neck. 24(1):78-83, 2002
                                                                                      31. Schmalfuss IM et al: Perineural tumor spread along the auriculotemporal nerve. AJNR Am J Neuroradiol. 23(2):303-11, 2002
                                                                                      32. Williams LS et al: Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis. Int J Radiat Oncol Biol Phys. 49(4):1061-9, 2001
                                                                                      33. Boerman RH et al: Trigeminal neuropathy secondary to perineural invasion of head and neck carcinomas. Neurology. 53(1):213-6, 1999
                                                                                      34. Ginsberg LE: Imaging of perineural tumor spread in head and neck cancer. Semin Ultrasound CT MR. 20(3):175-86, 1999
                                                                                      35. Caldemeyer KS et al: Imaging features and clinical significance of perineural spread or extension of head and neck tumors. Radiographics. 18(1):97-110; quiz 147, 1998
                                                                                      36. Curtin HD: Detection of perineural spread: fat is a friend. AJNR Am J Neuroradiol. 19(8):1385-6, 1998
                                                                                      37. Ginsberg LE et al: Greater superficial petrosal nerve: anatomy and MR findings in perineural tumor spread. AJNR Am J Neuroradiol. 17(2):389-93, 1996
                                                                                      38. Parker GD et al: Clinical-radiologic issues in perineural tumor spread of malignant diseases of the extracranial head and neck. Radiographics. 11(3):383-99, 1991