Neck Soft Tissue CT Scan (without contrast)

What it is

This is a scan of the contents of the neck, not of the neck bones. The slices cover the salivary glands, the thyroid, the chains of lymph nodes that run down either side, the tongue base, tonsils, voice box and the air column through the middle of it all. Without contrast, everything soft in the neck has a fairly similar density, so structures blend into one another — which is why the contrast-enhanced version is the one usually ordered. The unenhanced scan holds its own where the target is naturally bright: calcium. A stone blocking a salivary duct, a calcified node, a hard deposit in a gland — all stand out without any dye at all.

Why it is done

• To find a stone in a salivary duct or gland in someone whose jaw or neck swells painfully at mealtimes
• To look at the neck when injected contrast is not an option, for instance because of reduced kidney function or a previous reaction to contrast
• To assess an obviously calcified lump, or to check the extent of calcification in a gland
• As a quick look at the airway and surrounding tissue when contrast timing is impractical

What to expect

The patient lies on their back with the chin extended and shoulders pulled down, held still, while the table moves through the ring. It is over in a few minutes. There is no IV and no injection, so there is no need to fast beforehand for the scan itself, and no waiting period afterwards. Dental fillings and metal crowns can cause streaks across part of the image, and the technologist may angle the scan to work around them. The images go to a radiologist, who sends a report to whoever ordered the scan.

Questions worth asking

• Was an unenhanced scan chosen deliberately, or because contrast was unavailable? If a contrast study is likely to be repeated later, the two scans together cost more than one.
• Is an ultrasound of the neck an alternative for this question? It is generally the cheaper test for glands and superficial lumps.
• Will the radiologist's reading be billed separately from the scanner time?
• Is the imaging centre free-standing or hospital-based, and does that change whether a facility fee appears on the bill?