American College of Radiology
ACR Appropriateness Criteria®

Neck Mass/Adenopathy

Variant 1: Nonpulsatile neck mass(es). Not parotid region or thyroid. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 1 0 1 3 12
References Study Quality
14 (28891424) 4
19 () 4
20 (25476177) 4
25 (25476176) 4
26 (25978199) 4
27 (24847947) 3
28 (27542075) 4
29 (21493241) 4
31 (25944574) 3
32 (23449649) 4
MRI neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 1 0 0 0 2 1 9 4
References Study Quality
28 (27542075) 4
13 (23641590) 3
14 (28891424) 4
19 () 4
34 (16448927) 3
35 (18995981) 3
36 (13679283) 3
37 (28438298) 4
MRI neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 1 0 4 4 4 5 0 0
References Study Quality
28 (27542075) 4
13 (23641590) 3
14 (28891424) 4
19 () 4
34 (16448927) 3
35 (18995981) 3
36 (13679283) 3
37 (28438298) 4
US neck May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 0 2 0 3 5 5 2 1
References Study Quality
14 (28891424) 4
41 (18390388) 4
42 (24263756) 3
43 (20652889) 2
44 (27070179) 2
45 (24434158) 4
46 (15121245) 3
47 (26025577) 2
48 (26256915) 3
49 (24819862) 3
50 (20950927) 3
51 (25542937) 3
52 (23453381) 3
53 (26617244) 3
54 (23562011) 3
55 (24768485) 3
56 (23243639) 3
57 (23820176) 3
58 (24567918) 3
CT neck without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 1 2 2 4 8 0 0 0
References Study Quality
14 (28891424) 4
19 () 4
20 (25476177) 4
25 (25476176) 4
26 (25978199) 4
28 (27542075) 4
29 (21493241) 4
30 (25630849) 3
31 (25944574) 3
32 (23449649) 4
27 (24847947) 3
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 3 3 8 0 5 1 2 1 0 0 1
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 2 1 9 1 4 1 0 0 0
References Study Quality
14 (28891424) 4
19 () 4
20 (25476177) 4
25 (25476176) 4
26 (25978199) 4
28 (27542075) 4
29 (21493241) 4
30 (25630849) 3
31 (25944574) 3
32 (23449649) 4
27 (24847947) 3
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 9 1 5 2 0 0 0 0 1
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 7 3 4 0 3 0 1 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 8 3 3 1 2 0 1 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 2 0 0 0 0 0 0 1
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 1 1 10 1 4 2 0 0 0 0 1
Variant 2: Pulsatile neck mass(es). Not parotid region or thyroid. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 0 1 1 1 4 10
References Study Quality
32 (23449649) 4
33 () 4
CTA neck with IV contrast Usually appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 2 0 0 0 0 5 6 5
MRI neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 8 8 0 0 0 0 0 0 3 8 7
References Study Quality
59 (25476181) 4
60 (18339724) 2
61 (25410709) 2
MRA neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 1 1 0 2 2 6 4 2
References Study Quality
62 (23928233) 3
MRI neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 3 5 6 2 1 0
References Study Quality
59 (25476181) 4
60 (18339724) 2
61 (25410709) 2
US neck May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 0 2 3 6 3 3 1
References Study Quality
59 (25476181) 4
CT neck without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 2 2 2 2 7 3 0 0 0
References Study Quality
32 (23449649) 4
33 () 4
MRA neck without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 5 5 0 0 0 3 10 5 0 0 0
References Study Quality
62 (23928233) 3
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 4 6 3 2 2 0 0 0
References Study Quality
32 (23449649) 4
33 () 4
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 7 1 3 5 2 0 0 0 0
FDG-PET/CT skull base to mid-thigh Usually not appropriate Strong ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 12 2 4 0 0 0 0 0 0
References Study Quality
63 (26637204) 2
64 (28050631) 2
65 (26564322) 2
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Strong ☢☢☢ 1-10 mSv 1 1 14 1 3 0 0 0 0 0 0
References Study Quality
63 (26637204) 2
64 (28050631) 2
65 (26564322) 2
Variant 3: Parotid region mass(es). Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 9 9 1 0 0 1 0 0 0 7 9
References Study Quality
20 (25476177) 4
32 (23449649) 4
73 (25476182) 4
74 (18581165) 3
75 (17399933) 2
76 (17414771) 3
MRI neck without and with IV contrast Usually appropriate Strong O 0 mSv O 0 mSv [ped] 9 9 1 0 0 0 0 1 1 5 10
References Study Quality
74 (18581165) 3
77 (19629770) 2
78 (27093072) 4
79 (21724574) 2
80 (24948426) 3
81 (28074380) 3
82 (29101981) 4
83 (17502260) 2
84 (18504743) 3
85 (17213436) 3
86 (23703801) 3
87 (19131405) 2
US neck Usually appropriate Strong O 0 mSv O 0 mSv [ped] 7 7 0 0 1 0 4 2 6 3 2
References Study Quality
71 (23238699) 3
77 (19629770) 2
89 (24263755) 4
90 (28612315) 3
91 (19862655) 3
92 (25339101) 3
93 (25262550) 3
94 (23625388) 3
MRI neck without IV contrast May be appropriate Strong O 0 mSv O 0 mSv [ped] 6 6 0 1 0 0 5 7 5 0 0
References Study Quality
74 (18581165) 3
77 (19629770) 2
78 (27093072) 4
79 (21724574) 2
80 (24948426) 3
81 (28074380) 3
82 (29101981) 4
83 (17502260) 2
84 (18504743) 3
85 (17213436) 3
86 (23703801) 3
87 (19131405) 2
MRI neck with parotid sialography without and with IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 2 2 7 5 1 0
References Study Quality
88 (18478832) 3
MRI neck with parotid sialography without IV contrast May be appropriate Limited O 0 mSv O 0 mSv [ped] 6 6 0 0 1 3 5 7 1 0 1
References Study Quality
88 (18478832) 3
CT neck without IV contrast May be appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 5 1 2 0 2 11 0 2 0 0
References Study Quality
20 (25476177) 4
32 (23449649) 4
73 (25476182) 4
74 (18581165) 3
75 (17399933) 2
76 (17414771) 3
Fluoroscopy sialography parotid May be appropriate (Disagreement) Expert Opinion Varies Varies 5 4 2 1 1 6 5 2 1 0 0
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 3 3 1 2 9 0 5 0 1 0 0
References Study Quality
20 (25476177) 4
32 (23449649) 4
73 (25476182) 4
74 (18581165) 3
75 (17399933) 2
76 (17414771) 3
CT neck with parotid sialography Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 3 3 5 2 5 2 2 0 2 0 0
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 3 6 1 0 0 1 0 0
MRA neck without IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 6 2 0 3 0 0 0 1
MRA neck without and with IV contrast Usually not appropriate Expert Consensus O 0 mSv O 0 mSv [ped] 2 2 6 7 2 0 2 0 0 0 1
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 2 2 8 2 5 2 1 0 0 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 2 2 9 3 2 3 1 0 0 0 0
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 15 1 1 0 0 0 0 0 1
Variant 4: Child. Neck mass(es). Not parotid region or thyroid. Initial imaging.
Procedure Appropriateness Category SOE Adult RRL Peds RRL Rating Median Final Tabulations
1 2 3 4 5 6 7 8 9
CT neck with IV contrast Usually appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 8 8 0 1 0 1 1 1 4 3 7
References Study Quality
20 (25476177) 4
21 (24249813) 3
29 (21493241) 4
32 (23449649) 4
96 (25171800) 3
33 () 4
MRI neck without and with IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 1 1 0 0 0 0 5 5 6
References Study Quality
21 (24249813) 3
29 (21493241) 4
96 (25171800) 3
97 (8456703) 4
98 (10658158) 4
99 (24147487) 4
100 (10701595) 4
US neck Usually appropriate Limited O 0 mSv O 0 mSv [ped] 8 8 0 1 0 0 0 2 4 3 8
References Study Quality
41 (18390388) 4
59 (25476181) 4
101 (25476180) 4
102 (18830710) 3
103 (18455551) 4
104 (15645426) 3
105 (24485972) 3
MRI neck without IV contrast Usually appropriate Limited O 0 mSv O 0 mSv [ped] 7 7 0 0 0 2 2 2 9 1 2
References Study Quality
21 (24249813) 3
29 (21493241) 4
96 (25171800) 3
97 (8456703) 4
98 (10658158) 4
99 (24147487) 4
100 (10701595) 4
CT neck without IV contrast May be appropriate (Disagreement) Expert Opinion ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 5 6 3 0 1 3 2 7 2 0 0
References Study Quality
20 (25476177) 4
21 (24249813) 3
29 (21493241) 4
32 (23449649) 4
96 (25171800) 3
33 () 4
MRA neck without IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 2 6 4 0 1 0 0 0
References Study Quality
59 (25476181) 4
MRA neck without and with IV contrast Usually not appropriate Limited O 0 mSv O 0 mSv [ped] 3 3 5 1 6 4 1 1 0 0 0
References Study Quality
59 (25476181) 4
CTA neck with IV contrast Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢ 0.3-3 mSv [ped] 2 2 7 5 2 0 3 0 0 0 1
CT neck without and with IV contrast Usually not appropriate Limited ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 2 2 7 3 6 1 0 0 0 1 0
References Study Quality
20 (25476177) 4
21 (24249813) 3
29 (21493241) 4
32 (23449649) 4
96 (25171800) 3
33 () 4
Arteriography cervicocerebral Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv ☢☢☢☢ 3-10 mSv [ped] 1 1 17 0 0 0 0 0 0 0 1
FDG-PET/CT skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢☢ 10-30 mSv ☢☢☢☢☢ 10-30 mSv [ped] 1 1 14 1 2 1 0 0 0 0 0
FDG-PET/MRI skull base to mid-thigh Usually not appropriate Expert Consensus ☢☢☢ 1-10 mSv 1 1 14 2 2 0 0 0 0 0 0
Appendix Key

A more complete discussion of the items presented below can be found by accessing the supporting documents at the designated hyperlinks.

Appropriateness Category:The panel’s recommendation for a procedure based on the assessment of the risks and benefits of performing the procedure for the specified clinical scenario.

SOE: Strength of Evidence. The assessment of the amount and quality of evidence found in the peer reviewed medical literature for an appropriateness recommendation.

  • References: The citation number and PMID for the reference(s) associated with the recommendation.
  • Study Quality: The assessment of the quality of an individual reference based on the number of study quality elements described in the reference.

RRL: Relative Radiation Level. A population based assessment of the amount of radiation a typical patient may be exposed to during the specified procedure.

Rating: The final rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Median: The median rating (1-9 scale) for the procedure as determined by the panel during rating rounds.

Final tabulations: A histogram showing the number of panel members who rated the procedure as noted in the column heading (ie, 1, 2, 3, etc.).

Additional supporting documents about the AC methodology and processes can be found at www.acr.org/ac.