الفهرس 
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Abstract
MRI is considered the main imaging modality for diagnosis of perineural spread of head and neck malignancies. In addition to accurately identification of early signs of Perineural spread, it also can accurately delineate the extent of the primary disease.
MRI has major advantages over contrast enhanced CT and PET/CECT; it has superior soft tissue resolution and less dental artifact. In addition, it is better in assessment of intracranial tumour spread compared to CT. Moreover, it has less false positive and false negative results as compared to PET/CECT.
The aim of the study was to assess the role of magnetic resonance imaging in evaluation of perineural spread in patients with head and neck tumours, to illustrate common pathologies, and to assess MRI imaging of different neural pathways and delineate major radiological signs of perineural spread.
This study included fifteen patients referred to the Radio-diagnosis department at Alexandria Main University Hospital for MRI imaging; thirteen males and two females. The age range was between eleven and sixty nine years with mean age of forty three years old.
All of our fifteen patients were subjected to full history taking, thorough clinical assessment, and dedicated laboratory tests.
MRI sequences acquired in all of the cases included; pre-contrast axial T1WI, T2WI and coronal T2WI as well as axial T11WI with fat suppression. Post gadolinium contrast sequences acquired included; axial, coronal, sagittal T1WI in addition to axial T1WI with fat suppression.
Squamous cell carcinoma was the most commonly encountered tumour, in the current study, expressing perineural tumour spread; seen in seven cases, followed by mucoepidermoid carcinoma in five cases.
Trigeminal nerve was the most involved cranial nerve; its mandibular division was involved in twelve cases and maxillary division in five cases followed by vidian nerve in six cases and facial nerve in five cases. Perineural tumour spread most commonly involved foramen ovale, vidian nerve canal and stylomastoid foramen.
Perineural spread along facial nerve was a constant finding in all parotid tumours followed by mandibular division of trigeminal nerve. Mandibular division of trigeminal nerve was the most commonly involved nerve in nasopharyngeal carcinoma.
Nerve enhancement was the most common, early and constant MRI finding seen in all fifteen cases, followed by foraminal enlargement and obliteration of foraminal fat planes both seen in fourteen cases. Foraminal destruction and denervation atrophy are late and least common MRI signs.