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Review
. 2024 Jan 4;14(1):113.
doi: 10.3390/diagnostics14010113.

Diagnostic Accuracy of MRI in Detecting the Perineural Spread of Head and Neck Tumors: A Systematic Review and Meta-Analysis

Umida Abdullaeva  1 , Bernd Pape  2   3 , Jussi Hirvonen  4
Affiliations
Review

Diagnostic Accuracy of MRI in Detecting the Perineural Spread of Head and Neck Tumors: A Systematic Review and Meta-Analysis

Umida Abdullaeva et al. Diagnostics (Basel). .

Abstract

The purpose of this study was to review the diagnostic accuracy of MRI in detecting perineural spreading (PNS) of head and neck tumors using histopathological or surgical evidence from the afflicted nerve as the reference standard. Previous studies in the English language published in the last 30 years were searched from PubMed and Embase databases. We included studies that used magnetic resonance imaging (MRI) (with and without contrast enhancement) to detect PNS, as well as the histological or surgical confirmation of PNS, and that reported the exact numbers of patients required for assessing diagnostic accuracy. The outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Heterogeneity was assessed with the Higgins inconsistency test (I2). P-values smaller than 0.05 were considered statistically significant. A total of 11 retrospective studies were found, reporting 319 nerve samples from 245 patients. Meta-analytic estimates and their 95% confidence intervals were as follows: sensitivity 0.85 (0.70-0.95), specificity 0.85 (0.80-0.89), PPV 0.86 (0.70-0.94), and NPV 0.85 (0.71-0.93). We found statistically significant heterogeneity for sensitivity (I2 = 72%, p = 0.003) and PPV (I2 = 70%, p = 0.038), but not for NPV (I2 = 65%, p = 0.119) or specificity (I2 = 12%, p = 0.842). The most frequent MRI features of PNS were nerve enlargement and enhancement. Squamous cell carcinoma and adenoid cystic carcinoma were the most common tumor types, and the facial and trigeminal nerves were the most commonly affected nerves in PNS. Only a few studies provided examples of false MRI diagnoses. MRI demonstrated high diagnostic accuracy in depicting PNS of cranial nerves, yet this statement was based on scarce and heterogeneous evidence.

Keywords: cranial nerves; head and neck tumors; magnetic resonance imaging; meta-analysis; perineural spread; systematic review.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
PRISMA flowchart of systematic review and meta-analysis.
Figure 2
Figure 2
Forest plots of the sensitivity (A) and specificity (B) values from individual studies and their model-based estimates. Bars represent 95% confidence intervals, and dotted lines represent the model-based estimates. Data shown from original publications: (A) [19,21,22,28,30], (B) [16,19,20,21].
Figure 3
Figure 3
Forest plots of the PPV (A) and NPV (B) values from individual studies and their model-based estimates. Bars represent 95% confidence intervals, and the dotted lines represent the model-based estimates. Data shown from original publications: (A) [16,19,20,21], (B) [19,21,30].
Figure 4
Figure 4
Frequency distribution of primary tumor histologies associated with PNS across studies.
Figure 5
Figure 5
Frequency distribution of cranial nerves afflicted with PNS across studies.
Figure 6
Figure 6
Frequency distribution of MRI features reportedly associated with PNS across studies.
See this image and copyright information in PMC

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References

    1. Badger D., Aygun N. Imaging of Perineural Spread in Head and Neck Cancer. Radiol. Clin. N. Am. 2017;55:139–149. doi: 10.1016/j.rcl.2016.08.006. - DOI - PubMed
    1. Moonis G., Cunnane M.B., Emerick K., Curtin H. Patterns of Perineural Tumor Spread in Head and Neck Cancer. Magn. Reson. Imaging Clin. N. Am. 2012;20:435–446. doi: 10.1016/j.mric.2012.05.006. - DOI - PubMed
    1. Abdelaziz T.T., Abdel Razek A.A.K. Magnetic Resonance Imaging of Perineural Spread of Head and Neck Cancer. Magn. Reson. Imaging Clin. N. Am. 2022;30:95–108. doi: 10.1016/j.mric.2021.06.017. - DOI - PubMed
    1. Mendenhall W.M., Amdur R.J., Williams L.S., Mancuso A.A., Stringer S.P., Mendenhall N.P. Carcinoma of the Skin of the Head and Neck with Perineural Invasion. Head Neck. 2002;24:78–83. doi: 10.1002/hed.10025. - DOI - PubMed
    1. Ibrahim M., Parmar H., Gandhi D., Mukherji S.K. Imaging Nuances of Perineural Spread of Head and Neck Malignancies. J. Neuro-Ophthalmol. 2007;27:129–137. doi: 10.1097/WNO.0b013e318067b8eb. - DOI - PubMed

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