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Ehab Hanna, MD; Emre Vural, MD; Emmanuel Prokopakis, MD; Ricardo Carrau, MD; Carl Snyderman, MD; Jane Weissman, MD

Arch Otolaryngol Head Neck Surg. 2007;133(6):541-545.

Objective  To evaluate the sensitivity and specificity of computed tomography (CT) and magnetic resonance imaging (MRI) in detecting perineural spread (PNS) of adenoid cystic carcinoma of the head and neck to the skull base.

Design  Adenoid cystic carcinoma of the head and neck frequently exhibits PNS across the skull base. Failure to detect PNS before treatment can have significant negative consequences on the planning and outcome of therapy. High-resolution CT, MRI, or both are used to evaluate the presence of PNS; however, their accuracy in detecting perineural involvement has not yet been determined.

Patients  Twenty-six consecutive patients with adenoid cystic carcinoma, who were treated with cranial base resection, were included in this study. The surgical resection specimens of all patients were thoroughly examined by 1 pathologist for the presence of PNS along cranial nerves or their named branches. A total of 38 nerves were examined, and PNS was defined as the presence of tumor in the perineural or endoneural space. The results of the preoperative imaging studies (CT and/or MRI) were then reviewed retrospectively by 1 head and neck radiologist, who was unaware of the pathology report. Radiological evidence of PNS was considered to be present on CT, MRI, or both if nerves showed evidence of thickening (regardless of enhancement), contrast enhancement (regardless of size), or widening of their bony foramina or canals.

Results  Histopathologic evidence of PNS was present in 25 (66%) of 38 named nerves. The sensitivity and specificity of CT in detecting PNS were 88% and 89%, respectively. Magnetic resonance imaging had a higher sensitivity (100%) and specificity (85%).

Conclusions  Perineural spread across the skull base is a frequent occurrence in patients with adenoid cystic carcinoma of the head and neck. Magnetic resonance imaging has a higher sensitivity and specificity than CT in detecting PNS along the base of the skull.

Author Affiliations: Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston (Dr Hanna); Departments of Otolarygology–Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock (Dr Vural); University of Crete School of Medicine, Crete, Greece (Dr Prokopakis); University of Pittsburgh Medical Center, Pittsburgh, Penn (Drs Carrau and Snyderman); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland (Dr Weissman).

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