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CT NECK CONTRAST

*Soft tissue neck CT with contrast (not c-spine)

INDICATIONS (1-6)

Neck Con Indicatins

  • Soft tissue mass of the neck-  x-ray or US inconclusive & MRI contraindicated

  • Lower cranial nerve syndromes or palsies- initial imaging

  • Unilateral & isolated palatal or tongue paralysis/weakness- initial imaging

  • Trapezius and sternocleidomastoid muscle paralysis/weakness (unilateral & isolated)- initial imaging

  • Vocal cord paralysis (unilateral & isolated)- initial imaging

  • Laryngotracheal injuries/trauma

  • Neck mass (non-pulsatile or pulsatile)

  • Parotid region mass

  • Hyperparathyroidism (primary)
    - initial imaging
    - Persistent or recurrent after parathyroid surgery

  • Hyperparathyroidism(secondary or tertiary)- initial imaging

  • Soft tissue infection of the neck:
    - Suspected Ludwig angina secondary to dental infection.
    - History of puncture wound with possible retained foreign body (x-ray normal)
    - No puncture wound, soft tissue gas on x-ray
    - Necrotizing fasciitis highly suspected

  • Thyroid cancer
    - differentiated, pre-op evaluation
    - differentiated, recurrence suspected
    - medullary, recurrence suspected

  • Suspected or diagnosed cancer of the oral cavity / oropharynx / hypopharynx / larynx / or cancer of unknown primary of the head and neck- initial staging

  • Suspected or diagnosed nasopharynx cancer or EBV-associated unknown primary of the head and neck- Initial staging

  • Suspected or diagnosed cancer of the paranasal sinuses or nasal cavity- Initial staging

  • Suspected or diagnosed cancer of a major salivary gland (parotid, submandibular, and sublingual glands) - Initial staging.

  • Treated cancer of the oral cavity / oropharynx / hypopharynx / larynx or cancer of unknown primary of the head and neck- Surveillance imaging or follow-up imaging for suspected or known recurrence.

  • Treated nasopharynx cancer or EBV-associated unknown primary of the head and neck-Surveillance imaging or follow-up imaging for suspected or known recurrence.

  • Treated cancer of the paranasal sinuses or nasal cavity- Surveillance imaging or follow-up imaging for suspected or known recurrence

  • Treated cancer of a major salivary gland (parotid, submandibular, and sublingual glands) - Surveillance imaging or follow-up imaging for suspected or known recurrence.

Neck Con Pt Prep

PATIENT PREPARATION

  • Patient able to lie still for ten minutes

  • Not claustrophobic (sedation may be given)

  • Cognitively capable of following basic instructions

  • Metal artefacts removed from the region of interest, including bra’s

  • No respiratory distress when lying supine

  • Not allergic to Iodine based Contrast

  • No known kidney disease (eGFR below 30 as per RANZCR), however, acute setting consultant may sign to continue with poor renal function

  • No hyperthyroidism, may induce thyroid storm

  • Patient to have 20G cannula in anterior cubital fossa.

  • Preferably patient fasted for 4 hours

Neck Con Anatomy

ANATOMY INCLUDED
 

CT Neck Contrast- Soft tissue window (axial)
CT Neck Contrast- Soft tissue window (coronal)
CT Neck Contrast- Soft tissue window (sagittal)
CT Neck Contrast- Bone window (axial)

REFERENCES

  1. Dammann, F., Bootz, F., Cohnen, M., Haßfeld, S., Tatagiba, M., & Kösling, S. (2014). Diagnostic imaging modalities in head and neck disease. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2014.0417

  2. Cunqueiro, A., Gomes, W. A., Lee, P., Dym, R. J., & Scheinfeld, M. H. (2019). CT of the neck: Image Analysis and reporting in the emergency setting. RadioGraphics, 39(6), 1760–1781. https://doi.org/10.1148/rg.2019190012

  3. American College of Radiology (ACR). Appropriateness Criteria. [Internet]. 2022 [Updated 2023, Cited 20 Feb 2024]. Available from https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria

  4. Radiopaedia. CT neck (protocol). [Internet]. 2010 [updated 23 March 2023, cited 20 Feb 2024]. Available from https://radiopaedia.org/articles/ct-neck-protocol-1?lang=gb

  5. Burke CJ, Thomas RH, Howlett D. Imaging the major salivary glands. Br J Oral Maxillofac Surg. Jun 2011;49(4):261-9. doi:10.1016/j.bjoms.2010.03.002

  6. Kuno H, Onaya H, Fujii S, Ojiri H, Otani K, Satake M. Primary staging of laryngeal and hypopharyngeal cancer: CT, MR imaging and dual-energy CT. Eur J Radiol. Jan 2014;83(1):e23- 35. doi:10.1016/j.ejrad.2013.10.022

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