Background: Neck masses encompass a diverse range of pathologies, necessitating accurate diagnostic tools for effective management. Multi-detector computed tomography (MDCT) and high-resolution ultrasonography (USG) are pivotal in evaluating these lesions.

Objective: To assess the diagnostic efficacy of MDCT and USG in characterizing neck masses, comparing their findings with histopathological results.

Methods: A prospective study was conducted at Kurnool Medical College, India, from 2017 to 2020, involving 60 patients with neck masses. USG and MDCT were performed, followed by fine needle aspiration cytology (FNAC) or histopathology (HPE). Lesions were categorized by location, morphological characteristics, and enhancement patterns. Sensitivity and specificity were calculated for both modalities.

Results: Thyroid lesions predominated (46%), followed by lymph node (25.6%) and salivary gland pathologies (25.6%). USG demonstrated 90% sensitivity and 92.5% specificity for benign thyroid lesions, while MDCT showed 98% sensitivity and 95% specificity. For malignant thyroid lesions, USG had 62.5% sensitivity and 98% specificity, and MDCT had 75% sensitivity and 96% specificity. Non-thyroid benign lesions had 84.6% sensitivity on USG and 92.3% on MDCT, while malignant non-thyroid lesions showed 33.3% sensitivity on USG and 75% on MDCT.

Conclusion: USG is an effective initial diagnostic tool, particularly for superficial lesions, while MDCT excels in anatomical delineation and staging of malignant lesions. Histopathology remains essential for definitive diagnosis.