Change in the z-axis location of the sternal notch in an arms-raised vs arms-down position on CT examinations

The aim of the study was to determine whether the sternal notch changes in its z-axis position in the arms raised vs arms down position on CT scans. A retrospective study was made of 132 consecutive CT scans of the neck and chest. We recorded the table position of the sternal notch and the most inferior slice through the thyroid gland on both scans, and the table position on the chest CT where the configuration of the head and neck vessels most closely corresponded to their configuration on the sternal notch slice of the neck CT. The sternal notch moved up an average of 8.4 mm (p<0.0001) when the arms were raised. In 44 cases (33.3%), the sternal notch moved up by ≥10 mm. In 6% of cases, the sternal notch moved upwards ≥20 mm. There was a slightly greater upward movement of the sternum in males of 2.57 mm (p = 0.0208). Mean upward motion of the sternal notch relative to the vessels was 7.74 mm (p<0.0001). Mean upward motion of the sternal notch relative to the thyroid was 8.98 mm (p<0.0001). In conclusion, the sternal notch moves upwards relative to the CT table and soft tissues in the neck and upper mediastinum when the arms are raised; the degree of upward motion is greater in males. This may have implications when categorizing nodes at the cervicothoracic junction on staging CT examinations, when deciding if nodes might be accessible to ultrasound-guided biopsy, and in classifying goitres.