Resources/Protocols
Soft-tissue neck MRI protocols
A crowded anatomic highway of airway, great vessels and nerves — where the constant enemy is the swallow reflex that wipes out fat suppression and blurs resolution.
Neck imaging is a discipline in motion control. A swallow during acquisition renders a sequence non-diagnostic, so timing the sequences around the patient's swallowing — and saturating the structures that move — is the core skill. The clinical questions are usually nodal (reactive versus malignant), glandular, or the relationship of a mass to the carotid and airway.
Deep-dive protocol guides
Full step-by-step protocols — positioning, per-sequence planning, parameters, artifacts and a review checklist for each study:
Studies in this region
- Lymphadenopathy / neck mass
- Squamous cell carcinoma staging
- Thyroid mass
- Parotid gland
- Submandibular gland
- MR sialography
- Brachial plexus
- Perineural spread
- Post-treatment neck
Planning
- Keep the neck neutral — hyperextension stretches the platysma and adds motion, flexion collapses the airway.
- Place an anterior saturation band over the oral cavity and tongue to kill involuntary motion signal.
- Coach the patient to swallow only in the quiet gaps between sequences, never during acquisition.
- Cover the hard palate to the aortic arch, including Waldeyer's ring superiorly and the supraclavicular nodes inferiorly.
- Use flow compensation to stop carotid pulsation obscuring the jugular nodal chains.
Sequences by study
| Sequence | Typical use | Why |
|---|---|---|
| Axial T1 | Anatomy map | Nodes grey, fat white — separates nodes from fat |
| Axial T2 fat-sat | Pathology detector | Malignant nodes lose the fatty hilum and brighten |
| DWI (b≈800) | Nodal characterisation | Malignant cells restrict diffusion |
| T1 fat-sat + contrast | Mass and perineural spread | Enhancement and skull-base tracking |
| MR sialography | Salivary ducts | Heavily T2-weighted; stones and strictures without contrast |
Mistakes that cost repeats
- Swallowing during acquisition — the single commonest cause of a non-diagnostic neck study.
- Hyperextending the neck and adding platysmal motion.
- Carotid pulsation ghosting across the jugular nodes without flow compensation.
- Insufficient superior or inferior coverage, clipping Waldeyer's ring or the supraclavicular nodes.
Common questions
- Why is swallowing such a problem in neck MRI?
- The oesophagus and larynx sit millimetres from the target anatomy. A swallow during data acquisition creates a wave of motion that destroys fat suppression and blurs the image, so the whole sequence often has to be repeated.
- How is swallowing motion controlled?
- By placing a saturation band over the oral cavity and tongue to null their signal, coaching the patient to swallow only in the quiet gaps between sequences, and setting the phase-encode direction so any residual ghost falls away from the nodal stations.
- How does MR sialography work without contrast?
- A heavily T2-weighted sequence with a very long echo time keeps static saliva in the ducts bright while background tissue signal decays — mapping the salivary ducts to find stones or strictures without any injection.
Try it in ScanFlo: Run a neck sequence while the patient swallows mid-acquisition, then again with them holding still, and compare. The swallow-blurred series is why timing and saturation bands are non-negotiable here.