European Radiology

, Volume 28, Issue 9, pp 3861–3871 | Cite as

Facial nerve tractography: A new tool for the detection of perineural spread in parotid cancers

  • René-Charles Rouchy
  • Arnaud Attyé
  • Maud Medici
  • Félix Renard
  • Adrian Kastler
  • Sylvie Grand
  • Irène Tropres
  • Christian Adrien Righini
  • Alexandre Krainik
Head and Neck



To determine whether facial nerve MR tractography is useful in detecting PeriNeural Spread in parotid cancers.


Forty-five participants were enrolled. Thirty patients with surgically managed parotid tumors (15 malignant, 15 benign) were compared with 15 healthy volunteers. All of them had undergone 3T-MRI with diffusion acquisition and post-processing constrained spherical deconvolution-based tractography. Parameters of diffusion-weighted sequences were b-value 1,000 s/mm2, 32 directions. Two radiologists performed a blinded visual reading of tractographic maps and graded the facial nerve average pathlength and fractional anisotropy (FA). We also compared diagnostic accuracy of tractography with morphological MRI sequences to detect PeriNeural Spread. Non-parametric methods were used.


Average pathlength was significantly higher in cases with PeriNeural Spread (39.86 mm [Quartile1: 36.27; Quartile3: 51.19]) versus cases without (16.23 mm [12.90; 24.90]), p<0.001. The threshold above which there was a significant association with PeriNeural Spread was set at 27.36 mm (Se: 100%; Sp: 84%; AUC: 0.96, 95% CI 0.904–1). There were no significant differences in FA between groups. Tractography map visual analyses directly displayed PeriNeural Spread in distal neural ramifications with sensitivity of 75%, versus 50% using morphological sequences.


Tractography could be used to identify facial nerve PeriNeural Spread by parotid cancers.

Key Points

• Tractography could detect facial nerve PeriNeural Spread in parotid cancers.

• The average pathlength parameter is increased in case of PeriNeural Spread.

• Tractography could map PeriNeural Spread more precisely than conventional imaging.


Facial nerve PeriNeural Spread Parotid cancers Tractography Track-weighted imaging 



Average pathlength




Constrained spherical deconvolution


Fractional anisotropy


Peripheral facial palsy


PeriNeural Spread




Track-weighted imaging


Facial nerve



The authors acknowledge the valuable assistance of Patrice Jousse for his work editing the MRI images and diagrams. We also thank Dr Louise Ball and Dr Jeanne Maurice for critically editing the manuscript.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Alexandre Krainik.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (MM) has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained (IRB 5891 for patients/ IRB 6705 for healthy volunteers).



diagnostic study

performed at one institution

Supplementary material

330_2018_5318_MOESM1_ESM.mp4 (12.8 mb)
ESM 1 (MP4 13106 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • René-Charles Rouchy
    • 1
    • 2
  • Arnaud Attyé
    • 1
    • 2
  • Maud Medici
    • 3
    • 4
  • Félix Renard
    • 2
  • Adrian Kastler
    • 1
    • 2
  • Sylvie Grand
    • 1
    • 2
  • Irène Tropres
    • 2
    • 5
  • Christian Adrien Righini
    • 6
  • Alexandre Krainik
    • 1
    • 2
  1. 1.Department of Neuroradiology and MRIGrenoble Alpes University Hospital – SFR RMN NeurosciencesGrenobleFrance
  2. 2.University of Grenoble Alpes, IRMaGeGrenobleFrance
  3. 3.Clinical Investigation Centre 1406 - Innovative TechnologyNational Institute of Health and Medical ResearchGrenobleFrance
  4. 4.Public Health DepartmentGrenoble Alpes University HospitalGrenobleFrance
  5. 5.IRMaGe, Inserm US 17, CNRS UMS 3552GrenobleFrance
  6. 6.Department of OtololaryngologyGrenoble Alpes University HospitalGrenobleFrance

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