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Min, Yoon, Bae, Rho, Kim, and Bae: MR Findings of Cervical Lymphadenopathy : Tuberculosis versus Metastasis1
Original Article

J Korean Radiol Soc 1998;38(3):415-423.

Published online: 17 December 1998

DOI: https://doi.org/10.3348/jkrs.1998.38.3.415

MR Findings of Cervical Lymphadenopathy : Tuberculosis versus Metastasis1

Seon Jung Min, M.D., Dae Young Yoon, M.D., Sang Hoon Bae, M.D., Young Soo Rho, M.D.2, Duck Hoan Kim, M.D.3, Hoon Sik Bae, M.D.4

1Departments of Radiology, Hallym University College of Medicine

2Departments of Otolaryngology, Hallym University College of Medicine

3Departments of Pathology, Hallym University College of Medicine

4Departments of Therapeutic Radiology Hallym University College of Medicine

Address reprint requests to: Dae Young Yoon, M.D., Department of Radiology, Hallym University College of Medicine, Kangdong Sacred Heart Hospital. It 445, Gil-dong, Kangdong-gu, Seoul, 134-/01 Korea. Tel. 82-2-224-2312 Fax. 82-2-488-0114

Copyright © 1998 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To determine the MR findings of cervical lymphadenopathy which distinguish tuberculous lymphadenitis(TL) from metastatic lymphadenopathy(ML).

Materials and Methods:

We retrospectively analyzed the MR findings of 14 patients with TL and 19 with ML. Thirty-nine lesions in 14 patients with TL and 80 lesions in 19 with ML were classified into three categories: conglomerate lesion (TL, 7 å ML, 8) å discrete lesion without necrosis (TL, 3 å ML, 15) å and discrete lesion with necrosis (TL, 29 å ML, 57). Between TL and ML, we compared age, sex, bilaterality, multiplicity, associated pulmonary tuberculosis, infiltration of adjacent fat, muscle, skin and subcutaneous tissue, margin, and signal intensities on Tl- and T2-weighted images. In discrete lesion, we also compared the minimal to maximal dimension ratio, and in discrete necrotic lesion, the thickness and evenness of rim enhancement, and the location and extent of necrosis.

Results:

There were statistically significant differences between TL and ML in age(34.7 ± 13.1 years å 56.1 土 14.3 years), male to female ratio(3 : 11; 13 : 6), bilaterality(l/l4; 10/l9), multiplicity(5 å Μ/19), and associated active pulmonary tuberculosis(7/l4; l/l9). On T2-weighted images, TL showed predominantly homogeneous (30/39) or high (20/39) signal intensity, similar to that of cerebrospinal fluid, but the signal inteusity of ML was predominantly heterogeneous(58/80), or lower than or similar to that of fat(4l/80). Between TL and ML, however, there were no statistically significant differences in infiltration of adjacent tissue, margin, signal intensity and its heterogeneity on Tl-weighted image, minimal to maximal dimension ratio, thickness and evenness of rim enhancement, or the location and extent of necrosis.

Conclusion:

In cervical lymphadenopathy, the existence of TL rather than ML is suggested by single or unilateral lesion in a young woman, by associated active pulmonary tuberculosis, or by homogeneous high signal intensity on T2-weighted MR images.

Keywords: Neck, MR, Lymphatic system, diseases Neoplasms, metastases Tuberculosis

REFERENCES

1.Reed DL., Whelan MA., Bergeron RT. CT of the infrahyoid neck. Radiology. 1982. 145:397–402.
2.이혜련, 황정원, 성규보, 우원형. 종격동임파절의결핵성임파선염과원발성폐암의CT 소견. 대한방사선의학회지. 1989. 25:911–916.
3.Holt GR., McManus Κ. Computed tomography in the diagnosis of deep neck infection. Arch Otolaryngol. 1982. 108:693–696.
4.Hardin CW., Harnsberger HR., Ostorn AG., Doxey GP., Davis RK., Nyberg DA. Infection and tumor of the masticator space: CT evaluation. Radiology. 1985. 157:413–417.
crossref
5.Som PM. Lymph nodes of the neck. Radiology. 1987. 165:593–600.
crossref
6.Dooms GC., Hricak H., Crooks LE., Magnetic resonance imaging of the lymph node: comparison with CT. Radiology. 1984. 153:719–728.
7.Glazer HS., Neimeyer JH., Balfe DM, et al. Neck neoplasm: MRI. Part I. initial evaluation. Radiology. 1986. 160:300–348.
8.Stark DD., Moss AA., Gamsu G., Clark OH., Gooding GAW., Webb WR. Magnetic resonance imaging of the neck. Part I: normal anatomy. Part II: pathologic findings. Radiology. 1984. 150:455–461.
9.Lindberg R. Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracks. Cancer. 1972. 291:1446–1449.
10.옥철수, 박찬섭, 이소현, 서창해, 안병엽, 정원균. 경부임파절질환의전산화단층촬영상: 형태학적소견에대한분석. 대한방사선의학회지. 1992. 28:817–822.
11.김영주, 성기준, 강명재, 김명준. 경부임파선결핵의전산화단층촬영소견. 대한방사선의학희지. 1992. 28:182–187.
12.Reed DL., Bergeron RT. Cervical tuberculosis adenitis: CT manifestation. Radiology. 1985. 154:701–704.
13.위주환, 김홍수, 김동오, 소현순, 이학송. 경부임파절질환의전산화단층촬영소견: 감별진단을중심으로. 대한방사선의학희지. 1985. 154:701–704.
14.Vineger LK., Griffin W. The occult primary tumor. Arch Otolaryngol. 1973. 98:159.
15.Applig D., Miller RT., Houston TX. Mycobacterial cervical lymphadenopathy. 1981 update Layrngoscopy. 1981. 91:1259–1266.
16.Muraki A A., Mancuso A A., Hansberg HR. Matastatic cervical adenopathy from tumors of unknown origin: the role of CT. Radiology. 1984. 152:749–754.
17.오성식, 이연옥, 이지연등. 경부임파선종대의자기공명영상소견: 예비연구. 대한방사선의학회지. 1994. 31:197–203.
18.Som PM. Detection of metastasis in cervical lymph node: CT and MR criteria and differential diagnosis. AJR. 1992. 158:961–969.
19.David PL., Kaufman L., Crooks LE. Tissue characterization. In: Margulis AR, Higgins CB, Kaufman L, Crooks LE, eds. Clinical magnetic resonance imaging. San Francisco: Radiology Research and Education Foundation. 1983. 53–77.
20.van den Brekel MWM., Stel HV., Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology. 1990. 177:379–384.
crossref
21.Epstein RM., Mann JH. CT of abdominal tuberculosis. AJR. 1982. 139:861–866.
22.Dahlene DH., Stanly RT., Koehler RE, et al. Abdominal tuberculosis: CT findings. J Comput Assist Tomogr. 1984. 8:443–445.
crossref
23.Kissone JM., Anderson WAD. Anderson s pathology. 8th ed.ST. Louis: Mosby;1985. 1:p. 65.
24.Shapeero LG., Blank N., Young SW. Contrast enhancement in mediastinal and cervical lymph node. J Comput Assist Tomogr. 1983. 7:242–244.
25.Lee AS., Weissleder R., Brady TJ., Wittenberg J. Lymph nodes: microstructural anatomy at MR imaging. Radiology. 1991. 178:519–522.
crossref
26.van den Brekel MWM., Castelijns JA., Stel HV, et al. Detection and characterization of metastatic cervical adenopathy by MR imaging: comparison of different MR techniques. J Comput Assist Tomogr. 1990. 14:581–589.
27.David M., Peter M., David B., Schwaibold F., Robert A. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT. Radiology. 1992. 182:753–759.
crossref

Fig. 1.
MR images of 15-year-old women with tuberculous lymphadenitis. A. Axial Tl-weighted image shows a discrete lymph node(arrows) with necrosis at level II on right side. Note slightly high signal intensity in peripheral portion and relatively low signal intensity in central area of the lesion. B. Coronal Τ 2-weighted image shows multiple enlarged lymph nodes that have homogeneously high signal intensities similar to that of cerebrospinal fluid(arrows). C & D. Gd-DTPA enhanced axial (c) and coronal(D) Tl-weighted images, obtained at the same levels as A and B, show uneven rim enhancement of the lesions(arrows).
jkrs-38-415f1.tif
Fig. 2.
MR images of 52-year-old man with tuberculous lymphadenitis. A. Axial Tl-weighted image shows multiple conglomerate lymph nodes in the right posterior triangle and internal jugular chain(arrows), slightly hyperintense to muscle. B. On axial T2-weighted image, lymph nodes show homogeneous and high signal intensity similar to that of cerebrospinal fluid(arrows). C. On Gd-DTPA enhanced axial Tl-weighted image, some nodes have ringlike enhancement(arrows), some have homogeneous enhancement(open arrows) with extension into adjacent soft tissues (white arrows).
jkrs-38-415f2.tif
Fig. 3.
MR images of 54-year-old woman with metastatic lymphadenᄋpathy. A & B. Axial Tl-(A) and T2-weighted(B) images show two enlarged lymph nodes in the right neck with difference in signal intensity. Anterior node(arrows) has homogeneity in signal intensity on Tl-weighted image, and central low signal intensity with peripheral high signal intensity on T2-weightea image. But, posterior node(open arrows) has heterogeneity in signal intensity on Tl- and 12-weighted images. C. Gd-DTPA enhanced axial Tl-weighted image shows rim enhancement with multiple central non-enhancing portions in anterior node(arrow) and heterogeneous enhancement in posterior nodefopen arrow).
jkrs-38-415f3.tif
Fig. 4.
MR images of 36-year-old woman with metastatic lymphadenopathy. A. Axial Tl-weighted image shows an enlarged lymph node of signal intensity similar to that of muscle(arrow) at right parapharyngeal space. B. On axial T2-weighted image, lymph node shows heterogeneous and low signal intensity similar to that of fat(arrow). C. Gd-DTPA enhanced axial Tl-weighted image shows thick peripheral enhancement(arrow).
jkrs-38-415f4.tif
Table 1.
Comparison of Patients between Tuberculous Lymphadenitis and Metastatic Lymphadenopathy
Tuberculosis N=14(%) Metastasis N=19(%) P-value∗
Sex(M: F) 3: 11 13:6 < 0.05
Age(yrs) 34.7 士 13.1 56.1 ±14.3 < 0.05
Unilaterality < 0.05
   Unilateral 13(93) 9(47)
   Bilateral 1(7) 10(53)
Multiplicity < 0.05
   Single 9(64) 5(27)
   Multiple 5(36) 14(74)
Pulmonary tuberculosis 8(57) 6(31) NS
Active pulmonary tuberculosis 7(50) 1(5) < 0.05

Note- ∗Fisher's exact t-test, Unpaired two tail t-test, Chi-square test.

NS : statistically not significant

Table 2.
Location of Lymph Node in Tuberculous Lymphadenitis and Metastatic Lymphadenopathy∗
Location Tuberculosis Metastasis
N I 1 5
N II 5 14
N III 3 15
N IV 6 6
N V 5 6
Mediastinal 3 1
Parapharyngeal or ι “etropharyngeal 0 5

Note- ∗Location of lymph node by Som classification

Table 3.
Comparison of Adjacent Tissue Invasion between Tuberculous Lymphadenitis and Metastatic Lymphadenopathy
Tuberculosis N=15(%) Metastasis N=29(%) P-value∗
Adjacent fat invasion 8(53) 16(55) NS
Adjacent muscle in vasion 5(33) 14(48) NS
Dermal and subcuta neous manifestation 7(47) 8(28) NS

Note- ∗Chi-square test.

NS : statistically not significant

Table 4.
Comparison of MR Characteristics of Lesions between Tuberculous Lymphadenitis and Metastatic Lymphadenopathy
Tuberculosis N=39(%) Metastasis N=80(%) P-value∗
Type NS
   Conglomerate 7(18) 8(10)
   Discrete, non-necrotic 3(8) 15(19)
   Discrete, necrotic 29(74) 57(71)
Outer margin NS
   Well-defined 25(64) 39(49)
   Ill-defined 14(36) 41(51)
S.I. on T1WI NS
   (non-necrotic area)
    Muscle 35(90) 71(89)
   (Muscle 4(10) 9(11)
S.I. on T2WI < 0.05
   (non-necrotic area)
   =CSF 20(51) 14(18)
   Fat << CSF 13(33) 25(31)
   ≤ Fat 6(15) 41(51)
Heterogeneity of S.I. NS
   on T1WI
   Homogeneous 26(67) 67(84)
   Necrotic) non-necrotic 0(0) 0(0)
   Necrotic〈 non-necrotic 13(33) 10(12)
   Heterogeneous 0(㢌 3(4)
Heterogeneity of S.I. < 0.05
   on T2WI
   Homogeneous 30(77) 22(27)
   Necrotic) non-necrotic 6(15) 13(16)
   Necrotic〈 non-necrotic 0(0) 14(18)
   Heterogeneous 3(8) 31(39)

Note- ∗Chi-square test, Fisher's exact t-test

NS : statistically not significant, S.I.: Signal intensity,

T1WI: Tl-weighted image, T2WI: T2-weighted image

Table 5.
Comparison of MR Characteristics of Necrotic Lesions between Tuberculous Lymphadenitis and Metastatic Lymphadenopathy
Tuberculosis N=29(%) Metastasis N=57(%) P-value∗
Rim enhancement NS
   Thin and even 4(14) 10(18)
   Thick or uneven 25(86) 47(82)
Number of necrosis NS
   Single 17(59) 36(63)
   Multiple 12(41) 21(37)
Location of necrosis NS
   Concentric 10(34) 17(30)
   Eccentric 19(66) 40(70)

Note- ∗Chi-square test

NS : statistically not significant, T1WI: Tl-weighted image

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