From the Guidelines
Computed Tomography (CT) is the preferred imaging modality for a patient with a posterior neck mass that is rubbery, non-tender, and has increased in size over the past year.
Key Considerations
- CT has several benefits that support its utilization as a primary imaging modality, including being more readily available, costing considerably less, and being generally more easily tolerated by patients due to shorter scanning times and larger scanner bore 1.
- CT is effective in assessing neck masses and can help localize and characterize the mass, assess for additional nonpalpable masses, and screen visualized organs for potential sites of primary malignancy 1.
- 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 1.
Comparison with Ultrasound
- Ultrasound may be considered for initial imaging of parotid region masses or in children with neck masses, but it is not the preferred modality for a posterior neck mass in an adult 1.
- CT is superior to US for evaluating the extent of deep neck inflammation and can help identify a dental source of infection in the febrile patient 1.
Additional Recommendations
- MRI may be preferred when a primary tumor of the nasopharynx is suspected or when there is cranial nerve abnormality on physical examination, but it is not the first-line imaging modality for a posterior neck mass in an adult 1.
From the Research
Imaging Modalities for Posterior Neck Mass
The choice of imaging modality for a patient with a posterior neck mass that is rubbery, non-tender, and has increased in size over the past year depends on various factors.
- Ultrasound: Ultrasound is a useful initial imaging modality for assessing superficial soft tissue masses, including those in the neck 2. It is non-invasive, relatively inexpensive, and does not expose patients to radiation. However, its effectiveness may be limited by operator dependence and difficulty in evaluating deeper structures.
- Computed Tomography (CT): CT is a more comprehensive imaging modality that can provide detailed information about the size, location, and characteristics of the mass, as well as its relationship to surrounding structures 3, 4, 5. CT is particularly useful for evaluating deeper tissues and detecting potential complications such as invasion into adjacent structures.
Considerations for Choosing an Imaging Modality
When choosing an imaging modality for a patient with a posterior neck mass, several factors should be considered, including:
- Depth and location of the mass: Ultrasound may be sufficient for superficial masses, while CT may be necessary for deeper masses.
- Patient factors: Ultrasound may be preferred for patients who are pregnant, pediatric, or have a history of radiation exposure.
- Clinical suspicion: If there is a high suspicion of malignancy or other serious conditions, CT may be necessary to provide more detailed information.
Comparison of Ultrasound and CT
Both ultrasound and CT have their advantages and disadvantages. Ultrasound is non-invasive and relatively inexpensive, but may be limited by operator dependence and difficulty in evaluating deeper structures. CT provides more detailed information, but exposes patients to radiation and may be more expensive. The choice of imaging modality ultimately depends on the specific clinical scenario and the patient's individual needs 6.