J Korean Radiol Soc.  1998 Mar;38(3):415-423. 10.3348/jkrs.1998.38.3.415.

MR Findings of Cervical Lymphadenopathy: Tuberculosis Versus Metastasis

• Min SJ
• Yoon DY
• Bae SH
• Rho YS
• Kim DH
• Bae HS

• KMID: 2201395
• DOI: http://doi.org/10.3348/jkrs.1998.38.3.415

Abstract

PURPOSE: To determine the MR findings of cervical lymphadenopathy which distinguish tuberculouslymphadenitis(TL) from metastatic lymphadenopathy(ML).
MATERIALS AND METHODS
We retrospectively analyzed the MRfindings of 14 patients with TL and 19 with ML. Thirty-nine lesions in 14 patients with TL and 80 lesions in 19with ML were classified into three categories: conglomerate lesion (TL, 7; ML, 8); discrete lesion withoutnecrosis (TL, 3; ML, 15); and discrete lesion with necrosis (TL, 29; ML, 57). Between TL and ML, we compared age,sex, bilaterality, multiplicity, associated pulmonary tuberculosis, infiltration of adjacent fat, muscle, skin andsubcutaneous tissue, margin, and signal intensities on T1- and T2-weighted images. In discrete lesion, we alsocompared the minimal to maximal dimension ratio, and in discrete necrotic lesion, the thickness and evenness ofrim enhancement, and the location and extent of necrosis.
RESULTS
There were statistically significantdifferences between TL and ML in age(34.7+/-13.1 years; 56.1+/-14.3 years), male to female ratio(3:11; 13:6),bilaterality(1/14; 10/19), multiplicity(5/14; 14/19), and associated active pulmonary tuberculosis(7/14; 1/19). OnT2-weighted images, TL showed predominantly homogeneous (30/39) or high (20/39) signal intensity, similar to thatof cerebrospinal fluid, but the signal inteusity of ML was predominantly heterogeneous(58/80), or lower than orsimilar to that of fat(41/80). Between TL and ML, however, there were no statistically significant differences ininfiltration of adjacent tissue, margin, signal intensity and its heterogeneity on T1-weighted image, minimal tomaximal 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 unilaterallesion in a young woman, by associated active pulmonary tuberculosis, or by homogeneous high signal intensity onT2-weighted MR images.

Keyword

Neck, MR; Lymphatic system, diseases; Neoplasms, metastases; Tuberculosis

MeSH Terms

Cerebrospinal Fluid
Female
Humans
Lymphatic Diseases*
Male
Necrosis
Neoplasm Metastasis*
Population Characteristics
Retrospective Studies
Skin
Tuberculosis*
Tuberculosis, Pulmonary

Figure

• 

  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).

• 

  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).

• 

  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).

• 

  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).

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