Imaging Tips:Cervical Adenopathy

• Regardless of lymph node size, most reliable imaging finding of metastatic disease is presence of central nodal necrosis on contrast-enhanced CT
• Nodes in jugulodigastric region (level II), or submandibular triangles (level I) with greater than 1.5 cm in maximum diameter, or node greater than 1 cm in maximum diameter elsewhere in neck, are considered likely to contain metastatic carcinoma
• In general, nodal enhancement seems to imply increased nodal vascularity, most common causes are acute infections
• Nodal calcification can be seen in metastatic nodes (papillary thyroid cancer, metastatic adenocarcinoma from lung, breast and gut) but may also be seen with tuberculosis, healed necrotic, abscessed nodes, amyloidosis