Learning objectives
Imaging findings of perineural tumor spread.
It is necessary to identify the perineural tumor spread (PNTS) at early stage since there is poor prognosis
More change of recurrence occurs if PNTS is present.
Background
• Ability of a tumor to grow within and along nerve layers,
away from the primary site,
using the nerve as a route of spread is defined as perineural tumor spread.
• The tumor can invade any of the layers of the nerve (epineurium,
perineurium,
or endoneurium)
• Head and malignancies are more vulnerable for PNTS.
• Most commonly affected are the trigeminal nerve (cranial nerve V) and the facial nerve (cranial nerve VII),
because of their extensive innervations of the head and neck structures.
Findings and procedure details
•MRI and PET CT plays crucial role is early identification of perineural spread.•This exhibit demonstrates pathway of PNTS and explains the direct and indirect imaging findings of PNTS.•Direct: Abnormalities of the nerve and adjacent structures.•Indirect: Muscular asymmetry due to denervation atrophy.•Early imaging finding- Loss of the fat attenuation in the neural foramen or expected neural pathway•Late imaging finding- Asymmetric enlargement of the nerve pathway filled by soft tissue mass and erosion of the adjacent bone.
Case 1: FDG PET CT: 35 years,
male.
Right buccal...
Conclusion
Maxillary nerve is commonly involved in carcinoma of nasopharynx,
palate,
maxilla,
lip- the locations for abnormality to look for are foramen rotundum,
cavernous sinus and pterygopalatine fossa.
Mandibular nerve is commonly involved in carcinoma of mandible,
retromolar trigone,
masticator and parapharyngeal space- the locations for abnormality to look for are foramen ovale,
cavernous sinus,
mandible and inferior alveolar canal.
Facial nerve is commonly involved in carcinoma temporal bone,
parotid,
external auditory canal,
skin- the locations for abnormality to look for are course along the temporal...
Personal information
Presenter:
Dr.
Prakash Asokan,
DMRD,
DNB,
Fellow in Oncoradiology
HCG,
Bangalore India
Co-Authors:
Dr.
Shivakumar swamy shivalingappa,
DMRD,
DNB,
EDir
Consultant Oncoradiologist
HCG,
Bangalore India
Dr.
INDIRESH DESAI,
DMRD,
DNB
Consultant Oncoradiologist
HCG,
Bangalore India
Dr.
Avinash Kesari,
DMRD,
DNB
Consultant Oncoradiologist
HCG,
Bangalore India
Dr.
Mahesh Ashok kumar,
MD
Consultant Oncoradiologist
HCG,
Bangalore India
Dr.
Sudhakar Sampangi DMRD
Consultant Oncoradiologist
HCG,
Bangalore India
Acknowledgements:
Dr.
Kumar G Kallur
Director,
Imaging Services
HCG,
Bangalore
Dr.
Ajai Kumar
Chairman,
HCG,
Bangalore
References
1. Fabio M.
Paes,
Adam N.
Checkver,
Ricardo A.
Palmquist,
Gabriela De La Vega,
CharifSidani.
Perineural spread in head and neck malignancies: Clinical significance and evaluation with 18 F-FDG PET/CT.
Radiographics,
2013,
volume 33,
N0.6.
2. HansbergerR,
HudginsP,
Wiggins R,
Davidson C.
Salt Lake City,
USA: AMIRSYS; 2004.
Diagnostic Imaging: Head and neck,
1e.
