Soft Tissue Neck

IN COMPUTED TOMOGRAPHY

Frank Cairo R.T. ( R ) ( CT ) ( MR )

Learning Objectives

• To describe clinical indications for C.T. examinations of the neck soft tissue. To understand and recognize anatomy and landmarks. To show the proper scan protocols and procedures.

TOPICS• Gross anatomy• Neck anatomy facts• Patient prep• Indications• Patient prep• Scan protocols• Soft tissue neck slides

Gross Anatomy

• A horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage

• Level with the third cervical vertebra (C3) behind

• The hyoid is only distantly articulated to other bones by muscles or ligaments

Hyoid Bone

Hyoid Bone

Hyoid Bone

Thyroid Cartliage

• Know as the Adams apple• Largest and most superior in the neck• Level with C3-4• protect the vocal cords• Does not make a ring around trachea

Thyroid Cartliage

Cricoid Cartliage

• At the level of C6• Makes a ring around trachea• Applies attachments for muscles and

ligaments

Cricoid Cartliage

Thyroid Gland

• Largest gland in the neck• Has 2 lobes connected by the isthmus• Sometimes had pyramidal lobe• Controls how quickly the body uses energy,

makes proteins, and controls how sensitive the body is to other hormones

• Produces thyroid hormones

Thyroid Gland

Carotid Anatomy

Carotid Artery

Veins of the neck

Veins of the neck

Neck Circulation

1- rt common carotid artery2- rt internal jugular vein3- rt.subclavian artery4- brachiocephalic artery5- rt and lt brachiocephalic vein6- SVC7- lt common carotid artery8- lt internal jugular vein9- lt.subclavian artery10 – arotic arch

Lymph Nodes

Lymph Nodes

Salivary Glands

• exocrine glands, glands with ducts, that produce saliva

• Saliva for chemical digestion• 3 main glands and several minor• Parotid, Submandibular, and Sublingual

Salivary Glands

Salivary Glands

Airway

General Imaging Methods—Neck• Performed supine with neck slightly extended• Most often done in helical mode• IV contrast is used, unless contraindicated

– Split-bolus injection technique is used by some institutions• The goal is to allow sufficient time after contrast administration for

mucosa, lymph nodes, and pathologic tissue to enhance, yet acquire images while the vasculature remains opacified

• Neck broken into 3 compartments– Visceral

• Contains organs– Vascular

• Contains arteries and veins– Muscular

• Neck muscles– Landmarks

• Larynx c3-c6• Cricoid cartilage c5-c6• Carina T4-T5• Carotid bifurcation c3-c4• Thyroid cartilage c3-c4

Neck Anatomy Facts

• Diagnosis of neoplasms• Infections and abscesses• Thyroid mass• Salivary gland disorders• Vocal cord disorders

Indications

Patient Preparation• If exam is done with I.V. contrast patient must be

NPO 4-6 hours• Lab work for I.V. contrast exams• Follow all routine precautions for contrast

SINUSES

COLLIMATION 0.75mm

SLICE THICKNESS 3-5MM

FOV 14-20 CM

PITCH 1.0

WINDOW 450/30 NECK 4000/300 BONE

COLLIMATION 16X0.75

FEED/ROTATION 12 MM

INJECTION 100-120 ml @ 2-3ml/sec delay 25-30 sec

Soft Tissue Neck1- SVC

2- Brachiocephalic Artery

3- Lt. Common Carotid

4- Lt. Subclavian Artery

1

2

3

4

Soft Tissue Neck

1 2 34

5 1- Thyroid Gland

2- Common Carotid

3- Internal Jugular

4- Verterbral

5- Rt Subclavian

Below

Bifurcation

Above

cc cc IcEc

Neck

1

23 4 5

6

1- Internal Juglar vein

2- Submandibular Gland

3- Carotid Biufcuation

4- Hyoid Bone

5- epiglottis

6- Vertebral Artery

Neck1- Vertevbral Artery

Salivary Gland

11- Parotid Gland

Salivary Gland

1

1- Submandibular Gland

Neck1- Basilar Artery

2- Internal Carotid

Soft tissue neck

Copy right © 2007 by the American Roentgen Ray Society

Groell, R. et al. Am. J. Roentgenol. 2001;176:1571-1575

--85-year-old woman with metastases from squamous cell carcinoma of hypopharynx