Illustrated Approach to Imaging and Staging of Nodal Disease in the Neck

This article provides a review of the anatomic classification and staging of nodal disease in the neck through the use of tables, illustrations, and sample imaging cases. The article reinforces knowledge of nodal disease in the neck while reviewing imaging examples of common and uncommon disease entities in this region. We review nodal disease in the neck using American Joint Committee on Cancer staging criteria. We illustrate anatomy of the nodal levels of the neck with accompanying examples of selected cases. These are presented in an integrated manner, highlighting items of importance to radiologists. The accompanying images and clinical scenarios aid recognition with an emphasis on differential diagnosis. Case examples include a broad range of pathologically and clinically proven disease entities involving lymph node disease in the neck accumulated from 1999 to 2008 at a tertiary referral center. The anatomical relationships and major disease processes for this location are reviewed and illustrated with example images from commonly used imaging modalities for this region. Examples of cases discussed include lymphoma, metastatic neoplasms such as head/neck squamous cell carcinoma and esthesioneuroblastoma, and inflammatory and infectious processes such as mononucleosis. The reader will gain or refresh information about the anatomical relationships and demarcations of the nodal levels of the neck as well as disease entities that frequently present with neck adenopathy. This information is useful both in clinical practice and in preparation for certifying examinations. The images provided aid recognition with an emphasis on clinical context and differential diagnosis. A succinct review of patterns of nodal disease of the neck with anatomic orientation using illustrations of typical and atypical disease entities in this region enhance and reinforce understanding of this often complex area of imaging.