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Objective: To determine the diagnostic accuracy o f helical com puted tom ography (CT) in detection of m etastatic neck lymphadenopathy with histopathological correlation. Design: Comparative cross sectional study. Patients and Methods: This study was conducted in the Departments of Diagnostic Radiology and Pathology, Karachi from August 2005 to June 2006. A group o f 51 patients was included in this study. Helical CT scan was carried out after an IV bolus injection o f approxim ately 100 ml. o f contrast medium. CT scans were evaluated for metastatic lymphadenopathy i.e. abnormality o f nodal size and architecture and irregular nodal enhancement. The radiological findings on the CT scans were com pared with the pathological findings. Results: The study included 51 patients w ith age ranging from 22 to 77 years. Correct assessment of m alignancy was made on CT scan in 48 patients. CT scan was false positive in one and false negative in two patients. Conclusion: Contrast enhanced Helical CT proved to be accurate for preoperative evaluation and subsequent m anagement of cervical m etastatic neck adenopathy.