An imager’s guide to perineural tumor spread in head and neck cancers: Radiologic footprints on 18 F-FDG PET, with CT and MRI correlates

Hwan Lee, Jillian W. Lazor, Reza Assadsangabi, Jagruti Shah

Research output: Contribution to journalArticle

2 Scopus citations


Perineural spread (PNS) refers to tumor growth along large nerves, a macroscopic analog of microscopic perineural invasion. This phenomenon most commonly occurs in the head and neck, but its incidence varies with histologic tumor subtype. PNS results from a complex molecular interplay between tumor cells, nerves, and connective stroma. PNS is clinically underdiagnosed despite its impact on patients’ prognosis and management. The role of 18 F-FDG PET in assessment of PNS in head and neck cancer remains to be explored, in contrast to MRI as the established gold standard. In patients with PNS, 18 F-FDG PET shows both abnormality along the course of the involved nerve and muscular changes secondary to denervation. Assessment of PNS on 18 F-FDG PET requires knowledge of relevant neural pathways and can be improved by correlation with anatomic imaging, additional processing of images, and review of clinical context.

Original languageEnglish (US)
Pages (from-to)304-311
Number of pages8
JournalJournal of Nuclear Medicine
Issue number3
StatePublished - Jan 1 2019
Externally publishedYes



  • Correlative imaging
  • Cranial nerves
  • Head and neck cancer
  • Perineural spread

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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