Abstract Background: Conventional MRI has been working horse for diagnosis of perineural spread in head and neck cancer, either symptomatic or not. The purpose of this retrospective research is to collect data of asymptomatic patients to reveal conventional MRI signs with additional data on diffusion of primary tumor and perineural tissues. Aim of study: The aim of the current research is to evalu-ate MRI findings in exclusively “asymptomatic" patients with Pathologic-Radiologic proof of PNTS in head and neck malig-nancies. Patients and Methods: This retrospectively approached research aimed to collect patients' data from the clinico-ra-dio-pathologic Archives of Radiology department in our ter-tiary institution. These were collected from June 2021 to June 2023 staring by clinical archives. Results: Conventional signs included “nerve enhance-ment“(100%), “foraminal enlargement" (93.3%), “obliteration of foraminal fat"(93.3%),“foraminal destruction" (13.3%), intracranial extension (73.3%), muscular atrophy (20%). Dif-fusion was restricted at main tumor sites and inside foraminal nerve soft tissue of perineural invasion with low ADC <1 x 10-3 cm2/sec. Conclusions: MRI, including DWI, is essential in the eval-uation of perineural spread in head and neck cancer. The combi-nation of conventional MRI sequences and DWI provides com-prehensive information on the extent of tumoral spread, aiding in diagnosis, treatment planning, and prognosis.