review the appropriate approach for evaluation of metastatic cervical lymph nodes on cross-sectional neck imaging

the imaging assessment of nodal disease can be challenging for the radiologist because there are multiple sites to review and differing opinions about criteria for abnormal nodes. the ability to accurately detect nodal metastases is improved with knowledge of the criteria for abnormal nodes, the nodal drainage patterns, and common imaging pitfalls. in this article, we introduce these basic concepts and review the appropriate approach for evaluation of metastatic cervical lymph nodes on cross-sectional neck imaging. this presentation would cover the following topics: criteria for abnormal nodes which includes size, morphology, margin and internal content of the lymph nodes (cystic changes, ca, etc.), site classification based on the system devised by american head and neck society and american academy of otolaryngology-head and neck surgery, features important for staging and the radiologist’s role is to describe characteristics pertinent to the n staging. important features for management such as extra capsular spread. it would also have a brief review of advanced imaging techniques for nodal metastases and the indications for fna in head and neck lymphadenopathies.