Because of their increased sensitivity to spatially extended signals, cluster-size tests are widely used to detect changes and activations in brain images. However, when images are nonstationary, the cluster-size distribution varies depending on local smoothness. Clusters tend to be large in smooth regions, resulting in increased false positives, while in rough regions, clusters tend to be small, resulting in decreased sensitivity. Worsley et al. proposed a random field theory (RFT) method that adjusts cluster sizes according to local roughness of images [Worsley, K.J., 2002. Nonstationary FWHM and its effect on statistical inference of fMRI data. Presented at the 8th International Conference on Functional Mapping of the Human Brain, June 2-6, 2002, Sendai, Japan. Available on CD-ROM in NeuroImage 16 (2) 779-780; Hum. Brain Mapp. 8 (1999) 98]. In this paper, we implement this method in a permutation test framework, which requires very few assumptions, is known to be exact [J. Cereb. Blood Flow Metab. 16 (1996) 7] and is robust [NeuroImage 20 (2003) 2343]. We compared our method to stationary permutation, stationary RFT, and nonstationary RFT methods. Using simulated data, we found that our permutation test performs well under any setting examined, whereas the nonstationary RFT test performs well only for smooth images under high df. We also found that the stationary RFT test becomes anticonservative under nonstationarity, while both nonstationary RFT and permutation tests remain valid under nonstationarity. On a real PET data set we found that, though the nonstationary tests have reduced sensitivity due to smoothness estimation variability, these tests have better sensitivity for clusters in rough regions compared to stationary cluster-size tests. We include a detailed and consolidated description of Worsley nonstationary RFT cluster-size test.