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Computed tomography of the neck
Last reviewed: 05.07.2025
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If there are no contraindications, computed tomography of the neck is performed after intravenous administration of a contrast agent. The use of contrast agents allows for a more reliable determination of the presence of a malignant neoplasm and inflammatory process. For adequate enhancement of the neck vessels, a larger amount of contrast agent is required than, for example, for computed tomography of the head. In spiral computed tomography, scanning should begin at a strictly defined time after the administration of the contrast agent. Special recommendations and schemes for the administration of contrast agents are at the end of this manual.
Technique of computed tomography of the neck
By analogy with a head CT scan, a lateral topogram is first performed. This topogram is used to mark the levels of transverse (axial) scanning and the gantry rotation angle. Conventional neck sections are set at a thickness of 4-5 mm. Axial images are obtained on the monitor screen and when transferred to the printer as a view from below (from the caudal side). Thus, the right lobe of the thyroid gland is depicted to the left of the trachea, and the left lobe to the right.
Technique of computed tomography of the neck
Sequence of CT image analysis
There is not one correct technique for CT scans of the neck, but several systems for interpreting tomograms. The recommendations presented here have been developed based on clinical experience and are one of many options for beginners. Each specialist is free to choose his own strategy in the process of work.
Normal anatomy of the neck
The radiologist quickly runs into the limits of the resolution of CT (and perhaps his or her knowledge of anatomy) when attempting to identify each neck muscle. Individual muscles are of little clinical significance.
Sections of the neck usually begin at the base of the skull and continue caudally to the superior thoracic aperture. Sections that include the head therefore include images of the maxillary sinuses, nasal cavity, and pharynx. Behind the pharynx are the long muscles of the head and neck, which continue downward (caudally).
Neck pathology
Enlarged cervical lymph nodes are visualized as isolated nodular formations within one section and are rarely determined in adjacent sections. In large lymphomas and in lymph node conglomerates, areas of central necrosis are often encountered. In these cases, they are difficult to distinguish from an abscess with central decay. Usually, an abscess is surrounded by a zone of fatty tissue infiltration, the density of which is increased due to edema, as a result of which nerve trunks, arteries and veins become poorly distinguishable. In patients with immunodeficiency, abscesses can reach very large sizes. After the introduction of a contrast agent, the outer wall and internal septa of the abscess become stronger. The same picture is characteristic of a large hematoma or tumor with decay. In this case, it is difficult to make a differential diagnosis without a detailed study of the anamnesis.
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