Abstract:  To explore the characteristics and regulation of cervical lymph node metastases in hypopharyngeal carcinoma through computed tomography ( CT ) and magnetic resonance imaging (MRI), and to discuss the related factors to provide reference for clinical treatment. Methods: A retrospective analysis of patients treated at the Cancer Center of Sun Yat-sen University between August 2000 and December 2010; all 186 cases of hypopharyngeal carcinoma were pathologically confirmed and received pretreatment CT/MR examination. Univariate χ2 and multivariate logistic tests were used for statistical analysis. Results: The rate of regional lymph node metastasis for hypopharyngeal carcinoma was 79%; level II and III were the most common places of metastasis, with lymph node metastasis rates of 72.0% and 54.8%, respectively. The bilateral metastasis rates for pharyngeal wall and post-cricoid carcinoma were 53.3% and 50.0% among patients with lymph nodes metastasis. The contralateral lymph node metastasis rate for pyriform sinus carcinoma that invaded across the midline ( 40.0% ) was significantly higher than those that did not ( 11.1% ) ( P < 0.001 ). Both univariate and multivariate analysis revealed that a metastatic level of IV, metastasis to retropharyngeal lymph nodes, and esophageal invasion were significantly correlated with level VI lymph node metastasis. Conclusion: The incidence of lymph node metastasis in hypopharyngeal carcinoma is high, and follows specific patterns. The skip metastasis is rare. Midline tumors such as pharyngeal wall and post-cricoid carcinomas, as well as pyriform sinus carcinomas that invade across the midline are much more prone to have bilateral lymph node metastasis. Level IV metastasis, esophageal invasion, and retropharyngeal lymph node metastasis are likely independent factors for level VI metastasis.