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Objective: To determine the diagnostic accuracy of helical computed tomography (CT) in detection ofmetastatic neck lymphadenopathy with histopathological correlation. Design: Comparative cross sectional study. Patients and M ethods: 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 scanwas carried out after an IV bolus injection of approximately 100 ml. o f contrast medium. CT scans wereevaluated for metastatic lymphadenopathy i.e. abnormality of nodal size and architecture and irregular nodalenhancement. The radiological findings on the CT scans were compared with the pathological findings. Results: The study included 51 patients with age ranging from 22 to 77 years. Correct assessment ofmalignancy was made on CT scan in 48 patients. CT scan was false positive in one and false negative intwo patients. Conclusion: Contrast enhanced Helical CT proved to be accurate for preoperative evaluation and subsequentmanagement of cervical metastatic neck adenopathy.