Computed tomography of the neck

Jo Carlos R. Martinez, M.D.*t

Bob W. Gayler, M.D.*

z
#{149}m
Haskins Kashima, M.D.

0. t. Stanley S. Siegelman, M.D.*

A
vOrth Ae

Computed tomography has become “the imaging modality of

choice” for the evaluation ofneck masses. Here, to facilitate the
interpretation ofsuch images, is a detailed exposition of the normal
cross sectional anatomy of the neck.

THIS EXHIBIT, A SELECTION OF THE GEN-

ERAL RADIOLOGY PANEL, WAS DISPLAYED
AT THE 67Th SCIENTIFIC ASSEMBLY AND
ANNUAL MEFI’INC OF THE RADIOLOGICAL
SOCIETY OF NORTH AMERICA, NOVEMBER
15-20, 1981, CHICAGO, ILLINOIS.
Introduction

Computed tomography, with its unique capacity for displaying bone, soft tissue
and airway detail, has rapidly become the imaging modality of choice in the eval-
uation of patients with neck masses.
This communication reviews the normal cross sectional anatomy of the neck
as depicted by CT using fifteen reference levels extending from the mastoid tip to
* From the Russell H. Morgan the thoracic inlet. The capabilities and limitations of this technique will be discussed,
Department of Radiology and Radio- and interesting cases that illustrate the use of CT in the diagnosis and management
logical Science, The Johns Hopkins of patients with head and neck tumors will be presented.
Medical Institutions, Baltimore, Mary-
land.
t Presently, Radiological Services, Material and Methods
Tampa General Hospital, Davis Islands,
Tampa, Florida.
This report is derived from the study of 140 patients referred for evaluation
From the Department of Laryn-
of head and neck tumors. Scans were obtained with a high resolution (AS&E Pfizer
gology and Otology, The Johns Hopkins
500) unit. The examinations were carried out in the supine position with the neck
Medical Institutions, Baltimore, Mary-
land. slightly hyperextended and during quiet breathing. The scanning plane was parallel
Address reprints requests to Carlos to the infraorbitomeatal line. In most instances 10 mm sections were obtained at
R. Martinez, M.D., Radiological Ser- 10 mm intervals using a 10 second exposure, 20 mA, and 120 kVp. In specific in-
vices, Tampa General Hospital, Davis stances, such as the evaluation of the larynx and trachea or the examination of an
Islands, Tampa, Florida 33606. uncooperative patient, a shorter (5 second) scanning time and higher (50) mA setting

Volume 3, Number 1 March 1983 RadioGraphics 9

CT of the neck Martinez et al.

were used. For the examination of hardening artifacts from the humeral and a low (-200 H.U.) level. This al-
pharyngeal, laryngeal or other small heads. This is particularly true in an lows visualization of minor irregu-
tumors, 5 mm sections were obtained obese patient with a short neck. This larities in the outline of the airway
at 5 mm intervals. We found the problem can be partially solved by that might be obscured if only soft
rapid intravenous infusion of a 30% using a “swimmer’s” position and tissue settings were used.
iodinated contrast material to be increasing the tube current. Artifacts To represent the normal anato-
helpful in the CT evaluation of neck from dental fillings can be avoided by my, 15 scans have been selected, be-
masses. One hundred cc were given obtaining open mouth views or by ginning at the level of the nasophar-
prior to the first scan; an additional slight changes in the scanning plane. ynx and extending to the thoracic
200 cc were infused at the rate of Motion artifacts produced by swal- inlet. This reference diagram depicts
approximately 20 cc per minute. This lowing can be avoided by asking the some of the structures at each level.
infusion rate was usually achieved patient to bite gently with the lips on Line drawings have been derived
without difficulty if a 19 gauge nee- the partially extruded tip of the from each scan; some anatomical
dle were used. Whenever there was tongue. structures not visualized on the ref-
need for greater enhancement of Scans should be viewed and erence scans are included in the line
vascular structures, an additional studied at different window widths drawings because of their clinical
bolus of 25 cc of a 60% contrast ma- and levels. Soft tissues are best viewed importance and constant relationship
terial was injected, followed imme- and photographed at a relatively wide to demonstrable anatomical land-
diately by two successive scans window (250 to 400 H.U.) and a marks.
through the area of interest. window level of approximately 40 In general, to simplify the fol-
We utilized a few technical H.U. Bone structures are best studied lowing discussion, structures that are
“tricks” in order to improve the with a wide window (1000 or more if bilaterally symmetrical and their
image by reducing artifacts. Scans at an expanded scale is available). The anatomic relationships will be de-
the level of the thoracic inlet are fre- airway should be viewed with a very scribed in terms of the structures of
quently compromised by beam wide window (1000 H.U. or more) one side of the neck only.

Upper Nasopharynx
! Lower Nasopharynx

..per Alveolar Ridge - Soft Palate

Oral Cavity - Uvula

Mandibular Angles - Submandibular Glands

;Free Border of Epiglottis - Sup. Horns of Hyoid

1Valleculae - Hypopharynx

Hyoid Body - Carotid Bifurcations

Thyroid Notch - Aryepiglottic Folds

Arytenoid Cartilages - Laryngeal Vestibule

jVocal Cords

Subglottis

1Cricoid Ring - Laryngotrachea

‘Upper Trachea - Thyroid Isthmus

First Ribs - Lower Thyroid Gland

ISTRUCTU RES

Figure 1

10 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 1-UPPER NASOPHARYNX

Figures 2A & 2B
This section demonstrates the rela-
tionship of the nasopharynx to the
prevertebral and pharyngeal muscu-
Iature and to the anterior arch of C 1.
It also demonstrates the torus tuba-
rius at the opening of the eustachian
tube. The nasopharyngeal air shadow
may be asymmetrical because of the
asymmetric distribution of lymphoid
tissue. The deep soft tissue planes in
the parapharyngeal space should be
symmetrical, however. The close re-
lationship of the nasopharynx to the
carotid sheath clarifies the basis for
the complex syndromes that arise
from disease in this region.

Figure 2A

Antrum
nt. Carotid

. Mandibular
Condyle

Facial N.

Mastoid Tip

Jugular V.
nt. Carotid A.
Eustachjan Torus

ix Cranial
Odontoid

Styloid Post. Arch Cl

x, xi, xii Cranial Nerves

nt. Jugular V.

Figure 2B

Volume 3, Number 1 March 1983 RadioGraphics 11

CT of the neck Martinez et al.

LEVEL 2-LOWER NASOPHARYNX

Figures 3A & 3B
Here, the infratemporal fossa is well
seen. It is limited laterally, by the
mandibular ramus and the parotid
gland; and anteriorly, by the pos-
terolateral wall of the maxillary an-
trum. The external carotid artery
proximal to the origin of the internal
maxillary artery is surrounded by
parotid gland tissue at this level. A
zone of low attenuation tissue (fat) is
normally present between the pha-
ryngeal musculature and the ptery-
Figure 3A
goid muscles. These zones are bilat-
erally symmetrical.

Mandibular

Retromandibula

Facial

Parotid Glan

Figure 3B

12 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 3-UPPER ALVEOLAR RIDGE-SOVr PALATE

Figures 4A & 4B
The oral cavity and the isthmus of the
pharynx are seen in this section. The
midportion of the parotid gland is
demonstrated. In adults, the parotid
gland is usually of relatively low at-
tenuation (less than surrounding
muscles and vascular structures)
because of variable amounts of fatty
infiltration of the parenchyma. The
retromandibular vein is commonly
visualized just posterior to the man-
dibular ramus. The main trunk of the
Figure 4A facial nerve, although not visualized
on the CT image, lies just lateral to
the retromandibular vein.

Soft Palate
Cavity

Antrum
Oropharynx
Masseter M.
Pharyngeal Constrictor M.

Int. Carotid A. Retromandibular V.

(Post. Facial V.)
Ext. Carotid A..
Post. Auricular V.

Sternocleidomastoid M.

Figure 4B

Volume 3, Number 1 March 1983 RadioGraphics 13

CT of the neck Martinez et al.

LEVEL 4-ORAL CAVITY-UVULA

Figures 5A & 5B
The tip of the uvula appears here as a
punctate structure in the middle of
the oropharynx. It is surrounded by
palatine tonsils and the oropharyn-
geal musculature (pharyngeal con-
strictor, palatoglossus and palato-
pharyngeus muscles). The posterior
belly of the digastric muscle is an im-
portant anatomical landmark. It lies
lateral to the carotid sheath and the
external carotid artery. The retro-
mandibular vein becomes the exter- Figure 5A
nal jugular vein after exiting from the
parotid gland.

)ular Ramus

I Carotid A.
:Jugular V.

Figure 5B

14 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 5-MANDIBULAR ANGLE-SUBMANDIBULAR GLAND

Figures 6A & 6B
The oropharynx, the base of the
tongue, and the upper portion of the
submandibular gland are well visual-
ized at this level. The internal and
external carotid arteries and the jug-
ular veins are in close proximity to the
oropharynx. The most inferior portion
of the parotid gland is separated from
the adjacent submandibular gland by
the stylomandibular ligament. The
stylohyoid and digastric muscles
separate the structures of the carotid
sheath from the submandibular
Figure 6A gland. The attenuation of the sub-
mandibular gland is usually greater
than that of the parotid gland.

haryngeal
Constrictor M.
Carotid A.
us N.
V.

Figure 6B

Volume 3, Number 1 March 1983 RadioGraphics 15

CT of the neck Martinez et al.

LEVEL 6-FREE BORDER OF EPIGLOUIS-SUPERIOR HORN OF HYOID

Figures 7A & 7B
This section demonstrates the rela-
tionship of the submandibular gland
to the base of the tongue and to the
free border of the epiglottis. The su-
perior horn of the hyoid is adjacent to
the internal and external carotid ar-
teries. The suprahyoid group of
muscles (stylohyoid, mylohyoid, and
geniohyoid) is visualized as a group in
this section.
Figure 7A

Epiglottis

Mandible

Submandibular Gland
and

.Sternoclejdomastoid M.

Int. Carotid A.
nt. Jugular V.

Semispinalis Capitis and

Semispinalis Levator Scapulae Mm.
Vertebral Body C3

Figure 7B

16 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 7-VALLECULAE-HYPOPHARYNX

Figures 8A & 8B
The valleculae, epiglottis and median
glossoepiglottic fold are seen at this
level. The asymmetry of the vallecu-
lae in Figure 8A is accounted for by
secretions on the right side. The val-
lecular spaces are best seen if scans
are obtained while the tongue is pro-
truding. The fat layer deep to the
sternocleidomastoid muscle is regu-
larly seen irrespective of the body
habitus of the patient. Muscle defini-
tion is dependent on intermuscular
fat rather than on muscle size. The
hyoid bone is a useful reference
structure.
Figure 8A

Hypoglossal N’

mt. Carotid ,8
onstrictor M.
Int. Jugular

?idomastoid M.

Figure 8B

Volume 3, Number 1 March 1983 RadioGraphics 17

CT of the neck Martinez et al.

LEVEL 8-HYOID BODY-CAROTID BIFURCATION

Figures 9A & 9B
The pre-epiglottic space is well dem-
onstrated because of its low (fat) at-
tenuation. A portion of the aryepig-
lottic fold is seen laterally. The carotid
artery bifurcates at this level in most
individuals, usually at the level of the Figure 9A
fourth or fifth cervical vertebral body.
Note the relationship of the internal
jugular vein to the carotid bifurca-
tion.

Sternocleidon

Figure 9B

18 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 9-THYROID NOTCH-ARYEPIGLOTHC FOLDS

Figures 1OA & lOB

The alae of the thyroid cartilage are
seen at the level of the thyroid notch
in this section. The pattern and extent
of ossification of the thyroid cartilage
is variable, but usually symmetrical.
On each side, the aryepiglottic fold
separates the laryngeal vestibule
from the pyriform sinus. The com-
mon carotid artery and the jugular
Figure 1OA vein lie under the sternocleidomas-
toid muscle posterolateral to the
thyroid lamina.

Thyroid

Aryepiglottic Fold

Ext. Jugular V.

C5

Levator

Semispinalis Capitis M.

Figure lOB

Volume 3, Number 1 March 1983 RadioGraphics 19

CT of the neck Martinez et al.

LEVEL lO-ARYTENOID CARTILAGES-LARYNGEAL VESTIBULES

Figures hA & 11B

Here the upper portions of the ar-
ytenoid cartilages are present post-
eroinferior to the aryepiglottic folds.
The corniculate cartilages are very
seldom calcified and cannot be iden-
tified within the aryepiglottic folds.
Visualization of the pyriform sinuses
may be improved by phonation (E- Figure 11A
E-E) or by a modified Valsalva ma-
neuver during the scanning period.

al Constrictor M.

Neural Foramen

Ext. Jugular’

Figure llB

20 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 11-VOCAL CORDS

Figures 12A & l2B

The level of the true vocal cords is
identified by the close apposition of
the anterior commissure to the inner
surface of the thyroid cartilages, as
well as by the presence of the vocal
process of the arytenoid cartilage.
The uppermost portion of the cricoid
Figure 12A ring is seen at this level forming the
posterior boundary of the glottic
space.

Anterior Commissure

Arytenoid Cartilage

Int. Jugular V.

Middle and
Post. Scalene Mm.

Vertebral

Figure 12B

Volume 3, Number 1 March 1983 RadioGraphics 21

CT of the neck Martinez et al.

LEVEL 12-SUBGLOTFIS

Figures 13A & 13B

Here the mucosa of the subglottis is
closely applied to the cricoid ring and
thyroid cartilage. The cervical
esophagus is posterior to the poste-
nor lamina of the cricoid. Note the
relationship of the cricoid lamina to
the inferior cornu of the thyroid car-
tilage. In children and young adults,
the carotid arteries and jugular veins
may be difficult to separate from the
adjacent muscles unless a rapid infu-
sion of contrast material is employed
during the examination. Normal Figure l3A
lymph nodes usually measure less
than 5 mm in diameter.

Horn Thyroid Cartilage

Cartilage
.Cricoid Cartilage

lnt. Jugular V.
Vagus N.

. Longus Colli M.

Deep
Vertebral Body C7

Figure 13B

22 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 13-CRICOID RING-LARYNGOTRACHEA

Figures 14A & 14B

The cricoid ring surrounds the airway.
The upper pole of the thyroid gland is
readily identified because of its high
attenuation which results from the
vascularity and iodine content of the
gland. The common carotid artery is
usually found posterior to the thy-
roid.
Figure 14A

Middle anc,

l Cervical V.

Post. ScalenE

tor Scapulae

Figure l4B

Volume 3, Number 1 March 1983 RadioGraphics 23

CT of the neck Martinez et al.

LEVEL 14-UPPER TRACHEA-THYROID ISTHMUS

Figuresl5A&15B
The thyroid isthmus is seen anterior
to the trachea at this level. The Ca-
rotid artery lies posterior to the thy-
roid gland while the jugular vein is
more laterally placed between the
anterior scalene and the sternoclei-
domastoid muscles. The jugular veins Figure 15A
are frequently asymmetrical, the
right being larger in most subjects.

Vertebral Body Ti

Figure l5B

24 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

LEVEL 15-FIRST RIB-LOWER THYROID GLAND

Figures 16A & l6B

This section, just above the thoracic
inlet, is at the level of the first rib. In-
dividual tracheal rings are visible in
older individuals if they have become
calcified. The esophagus is commonly
just to the left of the midline at this
level. The lower cervical nerves may
be seen directed inferolaterally be-
tween the anterior scalene and the
middle and posterior scalene muscle
group. The anterior scalenes may be
prominent in patients with chronic
Figure 16A obstructive pulmonary disease and
should not be mistaken for masses or
adenopathy.

Vertebral Body Ti

Figure l6B

Volume 3, Number 1 March 1983 RadioGraphics 25

 CT of the neck Martinez et al.

Case One

This 35 year old man had a past

history of papillary carcinoma of the
thyroid. He consulted a physician
because of a right parapharyngeal
mass.

Figure 17
A 2.5 cm partially cystic mass (arrowheads) in the right parapharyngeal
space displaces the styloid process (arrow) anteriorly and laterally.

Figure 18
Section obtained 2 cm caudad. The lateral pharyngeal wall is distorted
DIAGNOSIS
and the right submandibular gland is displaced anteriorly. The rela-
Metastatic papillary carcinoma tionship of the cystic mass to the carotid artery and jugular vein is
of the thyroid gland. demonstrated (arrow).

26 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

Case Two

This 68 year old man had two

palpable masses in the right parotid
region.

1%

Figure 19
This sialogram showing displacement of the ducts suggests a single in-
traparotid mass lesion (arrowheads).

Figure 20
Two sharply defined masses (arrowheads) are present in the right par-
DIAGNOSIS
otid. Note the clear visualization of the posterior facial vein within the
normal parotid tissue between the two masses. The study was per- Adenopathy-Hodgkin’s dis-
formed during the infusion of a contrast medium. ease.

Volume 3, Number 1 March 1983 RadioGraphics 27

CT of the neck Martinez et al.

Case Three

This 53 year old man was ad-

mitted for the evaluation of a supra-
glottic lesion. An asymptomatic left
parotid mass was noted on physical
examination.

Figure 21
A laryngogram shows a thickened epiglottis (arrowheads) and distortion
of the valleculae.

Figure 22
This scan shows a thickened epiglottis, obliteration of the valleculae and
infiltration of the pre-epiglottic space (arrow).

28 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

Figure 23
In this sialogram, ductal displacement in the lower portion of the su-
perficial lobe suggests an intraparotid mass.

Figure 24
DIAGNOSIS
This scan shows a sharply defined mass within the left parotid gland.
Moderate fatty infiltration of the parenchyma accounts for the low Carcinoma of the epiglottis and
density of both parotid glands. left parotid Warthin’s tumor.

Volume 3, Number 1 March 1983 RadioGraphics 29

CT of the neck Martinez et al.

Case Four

This 26 year old man had a

slowly enlarging left neck mass.

Figure 25
A cystic mass is seen between the mylohyoid muscle and deformed left
submandibular gland (arrow). The anterior portion of the mass extends
to the floor of the mouth.

Figure 26
DIAGNOSIS
At this level, the hyoid is seen to be displaced to the right by the lower
Left submandibular gland cyst portion of the mass. Note the lateral displacement of the submandibular
(ranula). gland (arrow).

30 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

Case Five

This 49 year old woman with

subglottic carcinoma had been
treated with radiotherapy five years
earlier. At this time, she had wheezing
and a palpable lesion of the left lobe
of the thyroid.

Figure 27
In this scan, a soft tissue mass (arrowheads) partially obliterates the
subglottic airway. Note the well defined soft tissue plane between the
cricoid and the mass in the left lobe of the thyroid (arrows).

Figure 28
Pathology Specimen. Laryngectomy and thyroidectomy were per-
formed after partial laser excision of the subglottic mass. The residual DIAGNOSIS
lesion of the left subglottis (arrowheads) and the lesion of the left lobe
Recurrent subglottic squamous
of the thyroid (arrows) are demonstrated.
carcinoma. Colloid cyst of the thy-
roid.

Volume 3, Number 1 March 1983 RadioGraphics 31

CT of the neck Martinez et al.

Case Six

This 39 year old woman had a

lump in the throat.

Figure 29
A lateral radiograph of the soft tissues of the neck shows a smooth mass
(arrowheads) in the base of the tongue displacing the epiglottis poste-
riorly.

Figure 30
In this CT scan (without contrast agent), there is a high density (atten-
uation) mass’ (arrowheads)
‘ ‘ ‘ in the base of the tongue. The attenuation
of this lesion is the same as that of the normal thyroid tissue, which is
DIAGNOSIS high because of its iodine content. The superior horns of the hyoid (ar-
Lingual thyroid. rows) are seen in either side of the mass.

32 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

Case Seven

This 76 year old woman had a

two year history of progressive airway
obstruction.

Figure 31
A CT scan at ‘Level 8’ shows a partially
‘ ‘ calcified subglottic mass arising
from the inner lamina of the cricoid. The outer lamina of the cricoid
cartilage appears intact.

Figure 32
A follow up study after an interval of 4 months and after partial laser
excision of the tumor shows unequivocal decrease in the size of the le- DIAGNOSIS
sion which coincided with clinical improvement. Chondrosarcoma of the larynx.

Volume 3, Number 1 March 1983 RadioGraphics 33

CT of the neck Martinez et al.

Case Eight

This 48 year old man had an

enlarging goiter and stridor.

Figure 33
A lateral xeroradiograph demonstrates a large neck mass (arrowheads)
with erosion of the cricoid ring (arrow) and narrowing of the subglottic
airway.

Figure 34
DIAGNOSIS
This CT scan shows a large mass (arrowheads) arising from the right lobe
Carcinoma of the thyroid with of the thyroid, erosion of the cricoid ring posteriorly (arrow) and
transmural subglottic extension. transmural extension.

34 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

Case Nine

This 29 year old man had a

slowly enlarging left neck mass. He
had previously been operated on for
a glomus tympanicum.

Figure 35
A sharply defined enhancing mass (arrowheads) under the sternoclei-
domastoid muscle displaces the left submandibular gland anteriorly.
The carotid bifurcation is usually located at the level of the hyoid
horns.

I
r

DIAGNOSIS
Figure 36 Carotid body tumor (glomus
In this left common carotid angiogram, a highly vascular mass is seen caroticum).
at the carotid bifurcation. Multiple small feeders arising from the prox-
imal internal and external carotid arteries are demonstrated.

Volume 3, Number 1 March 1983 RadioGraphics 35

 CT of the neck Martinez et al.

Case Ten

This 34 year old man had pal-

pable masses in the upper and lower
neck.

Figure 37
An oblique view of the cervical spine shows enlargement of the C2-3
neural foramen (arrow) on the left.

Figure 38
A small, well defined, lobulated mass (arrowheads) is seen anterior to
the scalene muscles in this CT scan. It minimally displaces the left carotid
artery and the left jugular vein. Note the asymmetry of the jugular veins
with a very large right jugular vein, a normal variant.

36 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

Figure 39
In this CT scan, a large lobulated
parapharyngeal mass is seen (ar-
rowheads). The internal carotid ar-
tery is displaced (white arrow) and
there is distortion of the lateral pha-
ryngeal wall on the left. The C2-3
neural foramen (black arrow) on the
left is enlarged, corresponding to the
radiographic finding.

DIAGNOSIS
Neurofibromatosis.

Volume 3, Number 1 March 1983 RadioGraphics 37

CT of the neck Martinez et al.

Case Eleven

This 62 year old man com-

plained of hoarseness.

Figure 40
A CT section at the level of the vocal cords demonstrates irregularity
of the margin of the enlarged left vocal cord (arrowheads). Note the
excellent definition of the laryngeal cartilages.

Figure 41
Normal subglottic region 5 mm below the vocal cords.

DIAGNOSIS
Squamous carcinoma of the left
vocal cord.

38 RadioGraphics March 1983 Volume 3, Number 1

Martinez et al. CT of the neck

Case Twelve

This 50 year old man had a mass

in the posterior neck.

Figure 42
A sharply defined mass with very low (fat) attenuation is visualized be-
tween the semispinalis capitis muscle and the splenius capitis
muscle.

DIAGNOSIS
Lipoma.

Volume 3, Number 1 March 1983 RadioGraphics 39

CT of the neck Martinez et al.

Conclusions characterization of mucosal surfaces. 133:145-149.

8. CT is most helpful in the detection of 8. Sons PM, ShugarJMA. Combined CT
1. Computed tomography is helpful in metastatic adenopathy, especially in sialogram. Radiology 1980; 135:
the evaluation of neck masses. Specif- obese patients. Reactive nodes, how- 387-390.
ically, it is capable of documenting ever, cannot be differentiated from 9. Som PM, Shugar JMA, Train JS et al.
tumor size, location and relationship to metastatic nodes Normal lymph nodes Manifestations of parotid gland en-
usually measure fewer than 5 mm in largernent: Radiographic, pathologic
adjacent structures; it can demonstrate
routes of tumor spread and provide diameter and reactive nodes usually and clinical correlations Part I-The
measure fewer than 15 mm in diame- autoimmune pseudosialectasis. Part
clues supporting a specific diagnosis.
ter. Large nodes with central necrosis Il-The diseases of Mikulicz’ syn-
2. Thorough knowledge of the normal
usually indicate metastatic involve- drome. Radiology 1981; 141:415-
cross sectional anatomy of the neck
ment. 426.
and meticulous tomographic tech-
9. The role of CT in the evaluation of 10. Stove DN, Mancuso AA, Rice D et al.
nique are mandatory. The examina-
tion should be planned on the basis of thyroid nodules is limited because of Parotid CT sialography. Radiology
the accuracy of nuclear medicine and 1981; 138:393-397.
the clinical presentation.
3. Intravenous contrast material given as ultrasound techniques. CT, however, 11. Mancuso AA, Hanafee WN. Corn-
is helpful in defining the extent of puted tomography of the head and
a rapid infusion during the examina-
paratracheal and thyroid masses by neck. Williams & Wilkins Balti-
tion provides the best enhancement of
defining the extent of tracheal corn- more/London: 1982.
the vessels, and thereby improves
recognition of key vascular struc- pression and transmural airway inva-
tures. sion.
4. The exact location and extent of tu-
mors in the infratemporal fossa and
parapharyngeal space is best evaluated Additional Readings
by CT. The detection of parapharyn-
geal tumors depends more on asym- 1. Carter BL, Karmody CS, Blickman
metry, and distortion of deep soft tis- JR, et al. Computed tomography and
sue compartments than on asymmetry sialography Part I-Normal anatomy Figtres included here that previously appeared in Martinez
Part Il-Pathology. J Comput Assist CR. Kashima H, Gayler BW, et al. COmputed tomography of
of the airway. CT does not provide a
the neck. Ann Otol Rhinol Laryngol 1982; 91:Supplement
histologic diagnosis or permit differ- Tornogr 1981; 5:42-53.
99 are reproduced with permission.
entiation between benign and malig- 2. Doubleday LC, Jing BS, Wallace S.
nant processes. An inflammatory Computed tomography of the infra-
process may mimic tumor infiltra- temporal fossa. Radiology 1981;
tion. 138:619-624. We gratefully acknowledge the cooperation of ow col-
5. CT is very useful in the evaluation of 3. Larsson 5, Mancuso AA, Hoover L et leagues in the Departments of Otolaryngology and Radiolo.
parotid tumors and will probably re- al. Differentiation of pyriform sinus gy and the expert assistance of the technical staff. We ap-
predate the typing of Ms. Agnes Bridges and Ms. Rose
place conventional sialography for the cancer from supraglottic laryngeal
Walker. The photoaphy of Mr. Henri Hessels is much ap-
assessment of tumor pathology of the cancer by CT. Radiology 1981; preoated.
parotid. Sialography, however, re- 141:427-432.
mains the procedure of choice for the 4. Mancuso AA, Calcaterra TC, Ha-
evaluation of inflammatory diseases of nafee WN. Computed tomography
the salivary glands. of the larynx. Rad Clin N Am 1978;
6. CT is extremely valuable for the XVI:195-208.
evaluation and staging of laryngeal 5. Mancuso AA, Bohman L, Hanafee
carcinoma. It is the best imaging mo- WN et al. Computed tomography of
dality for the evaluation of cartilage the nasopharynx: Normal and van-
erosion and tumor extension into the ants of normal. Radiology 1980;
pre-epiglottic, paraglottic and 137:113-121.
subglottic spaces. 6. Mancuso AA, Macen D, Rice D et al.
7. Current limitations of CT of the larynx CT. of cervical lymph node cancer.
are: (a) motion artifacts, (b) lack of AJR 1981; 136:381-385.
dynamic information, (c) inability to 7. Miller EM, Normal D. The role of
differentiate edema from tumor in- computed tomography in the evalu-
filtration and (d) lack of adequate ation of neck masses. Radiology 1979;

40 RadioGraphics March 1983 Volume 3, Number 1