| Abstract [eng] |
Objective and Tasks: The objective of this work is to perform a literature review on the radiological diagnostic features of perineural spread in head and neck tumors. To achieve this aim, the following tasks have been set: 1) To analyze the significance and role of various radiological imaging methods in diagnosing perineural tumor spread, highlighting the key magnetic resonance imaging sequences and parameters. 2) Based on the literature review, to formulate a strategy for reviewing radiological images aimed at improving the diagnosis of perineural tumor spread. 3) To describe the main radiological features of perineural spread in head and neck tumors and provide clinical examples. 4) To discuss differential diagnoses—conditions that may mimic perineural tumor spread on imaging studies. Methods: The articles analyzed in this study were identified using the "PubMed" and "Google Scholar" search engines. The titles of the retrieved studies were reviewed, abstracts were analyzed, and the full texts of publications meeting the inclusion criteria were thoroughly studied. Only original sources were included. The primary focus was on publications from 2014 to 2024, with a total of 63 publications selected for analysis. To illustrate the radiological features, images from examinations of two patients at the NVC and images from scientific literature are used in the study. Results: The study begins with a brief overview of general aspects: the concept of perineural tumor spread, its pathogenesis, epidemiology, clinical significance, and clinical manifestations in the head and neck region. Subsequently, radiological aspects of perineural tumor spread are analyzed in detail. The main radiological imaging methods used for diagnosing this pathology are discussed, with a particular focus on the significance of magnetic resonance imaging. The optimal parameters and sequences for assessing perineural tumor spread are examined in detail. Additionally, key anatomical aspects of cranial nerves are reviewed, and the most important diagnostic principles and radiological features aiding in the identification of this pathology are analyzed. Finally, the differential diagnosis of perineural tumor spread is discussed. Based on a literature analysis, a systematic examination plan has been developed for diagnosing perineural tumor spread in the facial and trigeminal nerve regions. Prepared tables summarize the key radiological signs of perineural tumor spread, as well as the symptoms of this pathology and essential anatomical landmarks for accurate diagnosis. Conclusions: The primary radiological methods for diagnosing perineural tumor spread are computed tomography, magnetic resonance imaging, and positron emission tomography. Among these, magnetic resonance imaging is considered the gold standard for diagnosing perineural tumor spread due to its high sensitivity and specificity. For optimal visualization of perineural tumor spread, it is essential to follow specific parameters and sequences that enable precise assessment of nerve structures and lesions. Additionally, adherence to a systematic diagnostic methodology is crucial in minimizing diagnostic errors. The radiological signs of perineural tumor spread are classified into primary and secondary signs. Primary signs include nerve contrast enhancement and thickening, enlargement or erosion of neural foramina or canals, obliteration of the fat layer and pterygopalatine fossa, tumor invasion into Meckel’s cave and the cavernous sinus, as well as increased linear uptake of radioactive fluorodeoxyglucose along the cranial nerve pathway. The most important secondary signs include muscle denervation, thickening and contrast enhancement of the superficial musculoaponeurotic system and signs of Eustachian tube dysfunction. Since these findings are not specific, it is essential to differentiate them from other conditions that may cause similar radiological changes and conduct a thorough clinical analysis. |
