MRI Neck — soft tissue
Skull base to thoracic inlet for a general survey, or a targeted small field-of-view block over the named subsite with a wider survey for nodes.
Typical, not policy
Timings, volumes and delays here are representative values drawn from published guidance. Scanner generation, injector, cardiac output and local preference all move them. Confirm against your department's own protocol before you rely on a number.
When to use it
- Suspected or known head and neck malignancy where soft-tissue extent, marrow invasion or perineural spread matters.
- Salivary gland mass, where MRI separates deep-lobe parotid lesions from extraparotid disease.
- Persistent neck lump with non-diagnostic ultrasound and cytology.
- Suspected deep neck space infection where CT is contraindicated or has left the extent unclear.
- Cranial neuropathy with suspected perineural tumour spread along the trigeminal or facial nerve.
Technique
- Axial and coronal T1 without fat suppression as the anatomical backbone — fat provides the contrast that outlines tumour, and fat-suppressing the pre-contrast T1 destroys it.
- Fluid-sensitive imaging by fat-suppressed T2 or STIR; Dixon techniques give more uniform suppression across the neck than frequency-selective saturation.
- Post-contrast fat-suppressed T1 in at least two planes.
- Diffusion-weighted single-shot echo-planar imaging with b values typically around 0-800 s/mm² for cellularity; effective fat suppression is essential or ghosting makes it unusable.
Where it goes wrong
- Fat-suppressing the pre-contrast T1, which flattens the tissue contrast that defines tumour margins and marrow invasion.
- Frequency-selective fat saturation failing at the air-tissue interfaces of the neck and skull base, producing both false bright and false dark regions.
- Dental amalgam artefact obliterating the oral cavity, which should be predicted at vetting rather than discovered at reporting.
- Swallowing during the high-resolution sequences.
- Coverage not extended to the skull base foramina when perineural spread is the actual question.
Clinical questions that reach this study
Contrast
Gadolinium, intravenous
Macrocyclic gadolinium agent at a typical single dose of about 0.1 mmol/kg, with fat-suppressed T1 after injection.
- Contrast is standard for inflammatory, infective and neoplastic neck questions. A purely anatomical or vascular question may not need it.
Acquisition
- Breathing
- Quiet breathing with instruction not to swallow, cough or move the tongue during acquisitions.
- Preparation
- Name the subsite. A whole-neck survey answers a nodal question but not a tongue-base or perineural one. Ask about extensive dental metalwork — it may make MRI of the oral cavity uninterpretable and shift the study to CT. Patients who cannot suppress swallowing for several minutes at a time will produce non-diagnostic high-resolution sequences.
Safety checks this protocol carries
Derived from the contrast agent and phases above, not authored here — which is why they cannot drift apart from what the protocol actually does.
- Kidney function and gadolinium-based contrast· radiographer at scan
- Intravenous access adequate for the planned injection· radiographer at scan
- MR safety screening for implants and foreign bodies· radiographer at scan