Multi-modal imaging technology was used to screen the cervical microlymph nodes of patients with head and neck squamous cell carcinoma. Based on the pathological results, radiotherapy was optimized to improve the quality of life of patients. CT or magnetic resonance imaging (MRI) examination before radiotherapy was performed in 36 patients with head and neck squamous cell carcinoma. Fifty-one microlymph nodes with ≤1 cm diameter were selected. Following the ultrasonic detection of relevant indicators, ultrasound-guided puncture biopsy was performed to confirm the pathology. Based on the multi-modal evaluation results, the target area and plan of radiotherapy was confirmed. We evaluated the dose to organs at risk before and after target optimization. The difference in the detection results was compared, and the 3-year local control rate of the lymph node region of interest was observed. The D_mean and V₃₀ of the parotid (left and right) and submandibular gland (left and right) and the V₅₀ of the mandibular gland (left and right) had significant differences before and after optimization in the microlymph node target area of the neck (p<0.05). After 3 years of follow-up, four patients had cervical lymph node recurrence in the high-dose irradiated field. The recurrence rate was 11.11%, and no local recurrence was observed in the microlymph node area of interest. Thus, multi-modal imaging technology is a safe and reliable method to further optimize radiotherapy target planning to distinguish between benign and malignant cervical microlymph nodes of head and neck squamous cell carcinoma.