Objective To study the CT performance for cervical lymph node metastasis and CT features of local recurrence after radiotherapy in NPC. Methods From January 2000 to January 2015, 200 NPC patients received CT scanning and were clinically confirmed in our hospital. CT imaging about cervical lymph node metastasis was analyzed and the pathological results were compared. CT imaging about 100 recurrent cases after radiotherapy was concluded. Results Through CT examination, the incidence rate of cervical lymph node metastasis was 88% (176/200); the rates of metastasis in retropharyngeal, superior deep cervical area, posterior triangle and neck, middle deep cervical area, interior deep cervical area and supraclavicular area were 59.7%, 74.4%, 25.6%, 62.9%, 49.3% and 27.6%; the rates of metastasis in submandibular lymphatic node, submental node and intraglandular parotid node were 7.3%, 1.7% and 2.8%. Based on CT enhancement scanning, 95.51% of lymph nodes were slightly and moderately enhanced with 1.28% of non-enhancement cases and 0.64% of significant enhancement cases. 50.6% of lymph nodes were evenly distributed; 35.8% of nodes were not evenly distributed. 6.8% of lymph nodes contained large areas of necrosis; 7.4% of nodes contained cyclic low-density areas. NPC majorly re-appeared in nasopharyngeal region. There were 94 recurrent cases in nasopharyngeal region, 5 cases in skull base, and 1 case of cervical lymph node; there were 48 cases of cervical lymph nodes with 20 cases in bilateral sides and the other cases in unilateral side. Conclusion For NPC patients, it is easy to appear the cervical lymph node metastasis, especially in retropharyngeal area and jugular vein. CT is typically appeared with a uniform density and in a regular way.