Radiological Imaging Findings of Perineural Spread in Head-and-Neck Malignancies: Literature Review

Abstract

Perineural Spread (PNS) is a critical mechanism of tumor progression in head and neck malignancies, often remaining clinically undetected until the advanced stages. Given its significant implications for treatment planning and patient prognosis, early and accurate diagnosis through radiological assessment is essential. This literature review explores the epidemiology, clinical significance, diagnostic modalities, and, in particular, the radiological characteristics of PNS. Magnetic Resonance Imaging (MRI) remains the gold standard for detecting PNS due to its superior soft tissue contrast and detailed evaluation of nerve involvement. Computed Tomography (CT) and Positron Emission Tomography (PET) serve as complementary imaging modalities, aiding in the assessment of bony changes and metabolic activity, respectively. This review highlights the key radiological features of perineural tumor spread, including nerve enhancement, foraminal enlargement, obliteration of fat planes, and secondary signs such as muscle denervation. Understanding these imaging findings is crucial for accurate staging, guiding therapeutic decisions, and optimizing the patient outcomes.