CT Neck Contrast-enhanced CT has the advantage of superior spatial resolution and is the preferred initial imaging modality for a palpable nonpulsatile neck mass in an adult, particularly considering the risk of head and neck cancer [14,19,25,26]. The presence and distribution of abnormal lymph nodes may be helpful when refining the differential as a reactive or malignant process and in guiding the search for an unknown primary malignancy [19,27,28]. Dual-phase CT imaging (without and with IV contrast) is not usually necessary. CT performed only without IV contrast may be helpful in some cases. CTA Neck There is no evidence to support the use of CT angiography (CTA) for evaluation of a nonpulsatile neck mass. MRI Neck The primary advantage of MRI is improved soft-tissue intrinsic contrast. Intrinsic T1-hyperintensity and fat suppression techniques can confirm fat-containing lesions in the neck [28]. Diffusion-weighted imaging can identify soft-tissue abscess [34]. Apparent diffusion coefficient values also have been proposed as a discriminator between benign and malignant nodal disease in the neck [34-36] and with intravoxel incoherent motion features for both primary and nodal disease [37]; however, histology is needed to confirm any suspected malignancy [13,14,19]. Motion artifact may be a significant issue, particularly for patients who have difficulty managing secretions that are due to neck disease. MRI performed without IV contrast may be helpful in some cases. MRA Neck There is no evidence to support the use of MR angiography (MRA) for evaluation of a nonpulsatile neck mass. US Neck The overall use of neck US in the United States has lagged behind the use of US in Europe and Southeast Asia, which is due, in part, to greater accessibility of CT and MRI in the United States [38-40]. For discrete cystic lesions of the neck, US may suffice to characterize a lesion prior to definitive management.
Neck Mass Adenopathy. CT Neck Contrast-enhanced CT has the advantage of superior spatial resolution and is the preferred initial imaging modality for a palpable nonpulsatile neck mass in an adult, particularly considering the risk of head and neck cancer [14,19,25,26]. The presence and distribution of abnormal lymph nodes may be helpful when refining the differential as a reactive or malignant process and in guiding the search for an unknown primary malignancy [19,27,28]. Dual-phase CT imaging (without and with IV contrast) is not usually necessary. CT performed only without IV contrast may be helpful in some cases. CTA Neck There is no evidence to support the use of CT angiography (CTA) for evaluation of a nonpulsatile neck mass. MRI Neck The primary advantage of MRI is improved soft-tissue intrinsic contrast. Intrinsic T1-hyperintensity and fat suppression techniques can confirm fat-containing lesions in the neck [28]. Diffusion-weighted imaging can identify soft-tissue abscess [34]. Apparent diffusion coefficient values also have been proposed as a discriminator between benign and malignant nodal disease in the neck [34-36] and with intravoxel incoherent motion features for both primary and nodal disease [37]; however, histology is needed to confirm any suspected malignancy [13,14,19]. Motion artifact may be a significant issue, particularly for patients who have difficulty managing secretions that are due to neck disease. MRI performed without IV contrast may be helpful in some cases. MRA Neck There is no evidence to support the use of MR angiography (MRA) for evaluation of a nonpulsatile neck mass. US Neck The overall use of neck US in the United States has lagged behind the use of US in Europe and Southeast Asia, which is due, in part, to greater accessibility of CT and MRI in the United States [38-40]. For discrete cystic lesions of the neck, US may suffice to characterize a lesion prior to definitive management.