Objective Comparative pathological analysis,Objective to improve the diagnosis and differential diagnosis of benign and malignant lesion MSCT. Methods The pathological results and CT findings of 69 cases of neck lesions were retrospectively analyzed. The borderline of benign and malignant lesions, fusion of lesions, rich blood supply, multiple lesions and Ring to strengthen were analyzed. Results 44 cases of Malignant lesions. There were 32 cases of lymph node metastatic carcinoma and 10 cases of lymphoma,1 case of malignant solitary fibrous tumor, 1 case of malignant transformation of pleomorphic adenoma of the submandibular gland. 25 cases of benign lesions. There were 16 cases of inflammatory disease, 5 cases of benign tumor, 3 cases of cyst and 1 case of panniculitis. Image performance of benign and malignant cervical lesions. Borderline:40 cases of malignant lesions, 4 cases of benign lesions. Lesion fusion:35 cases of malignant lesions, 7 cases of benign lesions, rich blood supply:36 cases were malignant lesions and 13 were benign lesions. Multiple lesions: 39 cases malignant lesions and 13 benign lesions. Ring to strengthen: malignant lesions 18 cases, benign lesions 13 cases. Conclusion The lesion in the lateral area of the neck was frequently seen with lymph node metastatic carcinoma. CT is more commonly seen as annular enhancement with central necrosis. However, the pathological basis of benign and malignant lesions is different. Boundary ambiguity and lesion fusion can be used as a reference for benign and malignant differential diagnosis. In order to accurately determine the lesion, it is necessary to combine clinical data and ultimately rely on pathology and immunohistochemistry.