Additionally, in suspected vascular malformation, MRI provides detail of trans-spatial extent and adjacent neurovascular structures [97,98]. The addition of contrast is usually helpful for evaluation of suspected vascular lesions [99]; however, it should be considered on a case-by-case basis as it is not always necessary to achieve diagnosis [100]. MRA Neck There is no evidence to support the use of MRA for evaluation of a palpable neck mass in a child, though time- resolved postcontrast MRA could be useful for evaluating venous malformations and other pathology [59]. Contrast may not be necessary for defining arterial anatomy. US Neck In children suspected of having a congenital abnormality, US is useful in differentiating solid from cystic neck lesions and in discriminating high-flow from low-flow vascular malformations [59,101-103]. Color-flow Doppler US is also helpful for characterizing vascular flow in solid lesions [41,104]. US may suffice for evaluation of superficial infection [105]. FDG-PET/CT Skull Base to Mid-Thigh There is no evidence to support the use of FDG-PET/CT for evaluation of a palpable neck mass in a child. FDG-PET/MRI Skull Base to Mid-Thigh There is no evidence to support the use of FDG-PET/MRI for evaluation of a palpable neck mass in a child. Arteriography Cervicocerebral There is no evidence to support the use of catheter angiography for evaluation of a palpable neck mass in a child. Summary of Recommendations Variant 1: CT neck with IV contrast or MRI neck without and with IV contrast is usually appropriate for the initial imaging of nonpulsatile neck masses, not parotid region or thyroid. These procedures are equivalent alternatives. Variant 2: CT neck with IV contrast, CTA neck with IV contrast, MRI neck without and with IV contrast, or MRA neck is usually appropriate for the initial imaging of pulsatile neck masses, not parotid region or thyroid. These procedures are equivalent alternatives, although CTA or MRA may be complementary to CT and MRI.
Neck Mass Adenopathy. Additionally, in suspected vascular malformation, MRI provides detail of trans-spatial extent and adjacent neurovascular structures [97,98]. The addition of contrast is usually helpful for evaluation of suspected vascular lesions [99]; however, it should be considered on a case-by-case basis as it is not always necessary to achieve diagnosis [100]. MRA Neck There is no evidence to support the use of MRA for evaluation of a palpable neck mass in a child, though time- resolved postcontrast MRA could be useful for evaluating venous malformations and other pathology [59]. Contrast may not be necessary for defining arterial anatomy. US Neck In children suspected of having a congenital abnormality, US is useful in differentiating solid from cystic neck lesions and in discriminating high-flow from low-flow vascular malformations [59,101-103]. Color-flow Doppler US is also helpful for characterizing vascular flow in solid lesions [41,104]. US may suffice for evaluation of superficial infection [105]. FDG-PET/CT Skull Base to Mid-Thigh There is no evidence to support the use of FDG-PET/CT for evaluation of a palpable neck mass in a child. FDG-PET/MRI Skull Base to Mid-Thigh There is no evidence to support the use of FDG-PET/MRI for evaluation of a palpable neck mass in a child. Arteriography Cervicocerebral There is no evidence to support the use of catheter angiography for evaluation of a palpable neck mass in a child. Summary of Recommendations Variant 1: CT neck with IV contrast or MRI neck without and with IV contrast is usually appropriate for the initial imaging of nonpulsatile neck masses, not parotid region or thyroid. These procedures are equivalent alternatives. Variant 2: CT neck with IV contrast, CTA neck with IV contrast, MRI neck without and with IV contrast, or MRA neck is usually appropriate for the initial imaging of pulsatile neck masses, not parotid region or thyroid. These procedures are equivalent alternatives, although CTA or MRA may be complementary to CT and MRI.