颈部淋巴结结核的CT诊断和鉴别诊断

目的:分析颈部淋巴结核的CT表现,探讨CT诊断价值及鉴别诊断。方法:对22例颈部肿块行CT平扫及增强扫描。全部病例均经病理证实。其中15例为颈部淋巴结结核,女9例,男6例,年龄20～38岁。4例为颈部淋巴结转移瘤;3例为颈部淋巴瘤。结果:颈部淋巴结结核病变好发部位为颈静脉链下、中组及颈后三角淋巴结与淋巴性肿瘤有区别。根据颈部淋巴结核CT扫描的形态,密度及周围脂肪间隙的情况,可反映颈部淋巴结结核的病理改变。结论:CT在颈部淋巴结结核的诊断方面有着重要的价值,不仅可以明确病变的部位、数目、大小、形态特征及周围情况,尚可以反映其病理改变。     

Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast-enhanced CT

OBJECTIVE: Tuberculosis in the abdominal lymph nodes may be difficult to distinguish from lymphomas. This study evaluated specific CT imaging criteria for differentiating these entities. MATERIALS AND METHODS: We retrospectively reviewed the anatomic distribution and CT enhancement patterns of disease in 69 patients, 26 (38%) with tuberculosis and 43 (62%) with untreated lymphomas involving abdominal lymph nodes. Of the patients with tuberculosis, five (19%) had disseminated disease and 21 (81%) had nondisseminated disease. Of the patients with lymphomas, 16 (37%) had Hodgkin's disease and 27 (63%) had non-Hodgkin's lymphoma. RESULTS: Disseminated and nondisseminated tuberculosis involved predominantly lesser omental, mesenteric, anterior pararenal, and upper paraaortic lymph nodes. Lower paraaortic lymph nodes were involved more often in Hodgkin's disease (15 patients [94%]), non-Hodgkin's lymphoma (24 patients [89%]), and disseminated tuberculosis (five patients [100%]) than in nondisseminated tuberculosis (one patient [5%]). Mesenteric lymph nodes were involved more often in disseminated tuberculosis (four patients [80%]) and nondisseminated tuberculosis (11 patients [52%]) than in Hodgkin's disease (one patient [6%]) (p < .01). Anatomic distribution was not different between disseminated tuberculosis and non-Hodgkin's lymphoma. Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a multilocular appearance, whereas lymphomatous adenopathy characteristically showed homogeneous attenuation (14 patients [87.5%] with Hodgkin's disease and 19 patients [70%] with non-Hodgkin's lymphoma [p < .01]). CONCLUSION: Our findings indicate that the anatomic distribution and specific enhancement patterns of lymphadenopathy seen on contrast-enhanced CT can be useful in differentiating between tuberculosis and untreated lymphomas of the abdominal lymph nodes.     

Peripheral T-cell lymphoma in the neck: CT findings of lymph node involvement

OBJECTIVE: To describe the CT findings of lymph nodes of the neck involved in peripheral T-cell lymphomas (PTCL). MATERIALS AND METHODS: Twenty-seven patients with pathologically proved PTCL with involvement of the lymph nodes of the neck were enrolled in this study. We retrospectively evaluated the lymph nodes on CT images with special attention to nodal necrosis, the margin, and enhancement patterns. RESULTS: In the 27 patients studied, nodal necrosis and ill-defined margin were seen in 11 (41%) and 19 (70%), respectively. Heterogeneous enhancement of enlarged lymph nodes was noted on CT images in 19 (70%) of 27 patients. Homogeneous enhancement without ill-defined margin and/or nodal necrosis was only seen in 6 of 27 patients (22%). CONCLUSION: Necrosis, an ill-defined margin, and heterogeneous enhancement of enlarged lymph nodes in the neck are relatively common CT features of PTCL. For patients with cervical lymph node enlargement, the presence of these findings may suggest high-grade non-Hodgkin's lymphoma, including PTCL.     

颈部肿大淋巴结的影像分析

目的探讨颈部肿大淋巴结影像表现特点,提高诊断的准确性。方法66例经临床和病理证实的颈部肿大淋巴结患者,均进行CT和/或MR I检查,对比分析他们的影像学表现。结果多发的转移性淋巴结与多发的结核性淋巴结在位置分布上有显著性差异(P=0.006)。转移性淋巴结环形强化20例,其薄壁环形强化19例,占95%,而淋巴结结核环形强化5例均为厚壁环形强化,两者具有显著差异性(P=0.000)。转移性淋巴结中心坏死占78%,而淋巴瘤仅占36%,两者有显著性差异(P=0.018)。结论根据颈部肿大淋巴结位置分布和影像表现特点,大部分可做出正确诊断。     

Computed tomography of neck lymph nodes involved with malignant lymphoma: comparison with ultrasound.

CT images of 24 patients with head and neck lymphoma were retrospectively reviewed, compared with ultrasonograms, and compared with CT images of 13 patients with lymph node metastases. In nine (38%) of 24 patients, some lymph nodes with lymphomatous involvement showed a spotty or linear pattern of contrast enhancement. In two of these nine patients, a dendritic pattern of contrast enhancement between multiple enlarged lymph nodes was observed. The same pattern appeared as spotty, linear, or dendritic hyperechoic areas on the ultrasonogram. None of 13 patients with lymph node metastases showed a spotty, linear, or dendritic pattern of contrast enhancement. Ten of 13 (77%) showed ring-like contrast enhancement on CE-CT images. The spotty or linear contrast enhancement in enlarged lymph nodes and the dendritic contrast enhancement in confluent lymph nodes could be useful CT findings in diagnosing nodal involvement with malignant lymphoma.     

Computed tomography enhancement characteristics of lymphomatous lymph nodes of the neck

OBJECTIVES: The objective of this study was to investigate prospectively CT contrast medium enhancement curves of lymphomatous lymph nodes of the neck. MATERIALS AND METHODS: Eleven patients with biopsy-proven lymphoma had their enlarged cervical lymph nodes examined with dynamic CT and compared with a control group. RESULTS: The mean contrast medium enhancement of the lymphomatous nodes was significantly lower than that of the control group in the time interval from 40 s to 180 s after injection. DISCUSSION: The enhancement pattern previously suggested from studies of retroperitoneal lymph nodes was confirmed in this prospective study of cervical nodes.     

FDG PET/CT appearance of multicentric Castleman's disease mimicking lymphoma

We report a case of a multicentric form of Castleman's disease with multiple lymph nodes showing intense FDG uptake on whole body scan mimicking non-Hodgkin's lymphoma. In this report, the patient had multiple cervical, mediastinal, hilar, retroperitoneal and abnormal lymph nodes in the groin. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography was performed before tissue sampling. (18)F-FDG/PET demonstrated multiple areas of increased uptake in cervical, mediastinal, hilar, retroperitoneal and groin lymph nodes, suggesting a generalized disease of the lymphatic system including non-Hodgkin's lymphoma. The final diagnosis is based on the histopathological findings of the material obtained from the cervical lymphadenectomy. The histological diagnosis was multicentric plasma cell variant of Castleman's disease. (18)F fluorodeoxyglucose positron emission tomography/computed tomography scan helped to identify the lymph nodes involved throughout the whole body, but did not help to differentiate non-Hodgkin's lymphoma. The clinical conclusions and PET/CT findings are described in this report.     

纵隔淋巴瘤与恶性肿瘤纵隔淋巴结转移在SCT增强扫描中的对比分析

目的:探讨恶性淋巴瘤及纵隔淋巴结转移在SCT增强扫描中的表现,提高其诊断与鉴别诊断的准确性。方法:收集2000年~2004年经穿刺活检病理及临床观察证实的恶性淋巴瘤13例(共55个淋巴结)及纵隔淋巴结转移者28例(共86个淋巴结)的增强SCT所见;观察和评价增大淋巴结的大小、形态、密度、强化特征等方面并对其进行对比分析。结果:淋巴瘤多为均一强化(25/55,45.5%)或呈薄壁环形强化(15/55,41.8%);纵隔转移淋巴结为厚薄不一环形强化和不均匀结节状强化(73/86,84.9%)。结论:SCT增强扫描有助于纵隔淋巴瘤与淋巴结转移的诊断与鉴别诊断。     

Computed tomography and ultrasonography of metastatic cervical lymph nodes in oral squamous cell carcinoma

OBJECTIVES: To define criteria for CT and US in differentiating cervical lymph node metastases in oral squamous cell carcinoma (SCC). MATERIALS AND METHODS: CT and/or US of 230 metastatic lymph nodes and 228 benign lymph nodes in 147 patients with oral SCC were retrospectively evaluated. The CT and US findings of each lymph node were compared with the histopathological findings. A metastasis was defined on CT as a lymph node with rim or heterogeneous enhancement, or measuring 10 mm or more in the short axis, regardless of enhancement pattern, and on US as having definite internal echoes, regardless of size, or without definite internal or hilar echoes, but measuring 10 mm or more in the short axis. A lymph node with hilar echoes or a ratio of the long to short axis (L/S ratio) of 3.5 or more was considered benign. A lymph node failing to comform to any of these categories was termed questionable. RESULTS: The positive predictive value (PPV) for CT was 90.8% and the negative predictive value (NPV) was 70.4%. However, 65.7% of all lymph nodes could not be classified as either metastastic or benign. PPV for US was 96.5% and NPV was 88.1%. 25.5% of all lymph nodes could not be classified as either metastatic or benign. CONCLUSIONS: Despite limitations in detecting metastases, by including a third category 'questionable' our criteria appear clinically more useful than other current methods based on two groups only.     

成人纵隔淋巴结结核与恶性淋巴瘤的MSCT对照研究

目的:探讨纵隔淋巴结结核与淋巴瘤的优势解剖分布及其MSCT表现.方法:纵隔淋巴结结核和淋巴瘤各30例行MSCT检查,按病变部位记录其大小、形态、密度、数量、有无坏死和融合、强化程度和方式、对纵隔血管有无侵犯和包埋等征象,并进行对比分析.结果:本组结果显示结核(10R,n=8;10L,n=9)比淋巴瘤(均为1例)更易累及10R和10L区淋巴结,而在其它纵隔解剖区分布上两者无明显差异.90%淋巴结结核呈环形强化(其中14.6%伴有分隔样强化,5.6%伴有小结节样强化),5%为均匀强化,5%无明显强化.91.8%淋巴瘤呈均匀强化,8.2%呈较均匀强化合并有部分坏死.同一部位多个淋巴结结核相对独立,即使粘连,也仍可分辨其单个淋巴结边界;淋巴瘤的肿大淋巴结常融合成块并侵犯纵隔结构.结论:纵隔淋巴结结核与纵隔淋巴瘤具有一定的优势解剖分布,根据两者的MSCT表现和强化特点可资鉴别.     

Simultaneous bilateral breast and high-resolution axillary MRI of patients with breast cancer: preliminary results

OBJECTIVE: The aims of this study were to develop a standardized one-step procedure for simultaneous high-resolution MRI of the axilla and bilateral breast MRI and to identify nodal features suggestive of metastatic involvement. SUBJECTS AND METHODS. We studied 16 women undergoing axillary lymph node dissection after combined bilateral breast MRI and high-resolution MRI of the axilla with a maximum in-plane resolution of 0.6 x 0.4 mm. MRI was performed using a standard double breast coil and a 15-cm round flexible surface coil adapted to the axilla. High-resolution axillary sequences, including inversion recovery T2- and spin-echo T1-weighted sequences, were performed before and after gadolinium chelates bolus injection. Axillary image analysis focused on nodal morphology including size, contour regularity, cortex and hilar appearance, signal intensity, and enhancement parameters. Axillary MRI findings were compared with the final pathogic results from axillary lymph node dissection in all patients. Patients were divided into groups according to the final pathologic axillary status. Differences in MRI lymph node features across the groups were tested using a t test for quantitative data and the chisquare test or Fisher's exact test for binary data. RESULTS: The features of the axilla on high-resolution MRI that best discriminated between patients with positive pathologic findings and those with negative pathologic findings were the presence of nodes with irregular contours (p < 10(-4)), high signal intensity on T2 sequences (p < 10(-3)), marked gadolinium enhancement (p < 10(-3)), and round hila and abnormal cortexes (p < 0.05). CONCLUSION: Breast tissue and axillary lymph nodes both can be analyzed on MRI in a one-step process using a bilateral breast coil combined with a surface coil. Morphologic features observed on high-resolution MRI of the axilla can improve the identification of metastatic nodes.     

Ultrasound of neck lymph nodes: How to do it and how do they look?

Cervical lymphadenopathy is commonly caused by metastases, lymphoma, tuberculosis and reactive hyperplasia. Before making an accurate diagnosis of pathologic lymph nodes, a clear understanding of the normal appearances of cervical nodes is crucial. Ultrasound examination of cervical lymph nodes is common in routine clinical practice because of its high sensitivity and specificity when combined with ultrasound-guided fine-needle aspiration cytology (FNAC). This article reviews the ultrasound of cervical lymph nodes including classification of the nodes, equipment, scanning technique and sonographic appearances of normal and common abnormal lymph nodes. The sonographic appearance of unusual cervical lymphadenopathy and the value of three-dimensional ultrasound in the volumetric measurements of cervical nodes are also discussed.     

An overview of neck node sonography

RATIONALE AND OBJECTIVES: Gray scale and power Doppler sonography are commonly used to evaluate cervical lymph nodes. This study was undertaken to identify which of the features used in ultrasound of cervical lymph nodes is readily applicable in routine clinical practice. METHODS: Two hundred and eight-six patients diagnosed with cervical lymphadenopathy were included in the study. The largest node in each patient was included in the study and the nature of the node was assessed by fine-needle aspiration cytology. Lymph nodes were assessed for their gray scale and Doppler sonographic features. RESULTS: Metastatic, lymphomatous, and tuberculous nodes were round (63-94%) and without echogenic hilus (57-91%). Sharp borders were found in metastatic and lymphomatous nodes (56-100%), but uncommon in tuberculosis (49%). Capsular or mixed vascularity is common in metastatic, lymphomatous, and tuberculous nodes but not found in reactive nodes. Except metastatic nodes from papillary carcinoma of the thyroid that showed low resistance, metastatic nodes had a higher vascular resistance than reactive nodes. Micronodular echo pattern is common in lymphomatous nodes. Hyperechogenicity and punctate calcification are typical features for metastatic nodes from papillary carcinoma of the thyroid. Intranodal cystic necrosis, adjacent soft tissue edema, matting and displaced hilar vascularity are common features in tuberculosis. CONCLUSIONS: Using gray scale and power Doppler sonography, metastatic, lymphomatous, and tuberculous nodes can be differentiated from reactive nodes. Metastatic nodes from papillary carcinoma, lymphoma, and tuberculosis can be identified. However, it is difficult to differentiate metastatic nodes from squamous cell carcinomas, nasopharyngeal carcinoma, and infraclavicular carcinomas, and differentiate metastatic nodes (nonthyroid primary) from tuberculous lymphadenitis.     

淋巴结反应性增生的CT诊断

目的分析淋巴结反应性增生的CT表现及CT的诊断价值。方法回顾性分析13例经手术及病理证实的淋巴结反应性增生的CT表现。结果13例淋巴结反应性增生中,单独侵犯颈外侧淋巴结7例,同时侵犯颈外侧区及面淋巴结、颏下淋巴结各2例,1例侵犯腋窝及腹股沟淋巴结,1例为颈、腋、纵隔、腹膜后区和腹股沟淋巴结同时肿大。肿大淋巴结短径最小0.6 cm,最大2.6 cm,平均1.6 cm。肿大淋巴结孤立存在12例,仅1例有融合。1例因相互融合而密度不均,12例密度均匀并有明显强化,增强后CT值增加19.1~113.2 HU,平均59.1 HU。结论淋巴结反应性增生的CT表现有一定的特征性,CT检查对该病的定性诊断与鉴别诊断具有重要价值。     

鼻咽癌颈部淋巴结转移的CT表现

目的 分析鼻咽癌颈部淋巴结转移的CT表现及特点.资料与方法 分析1991年至2006年有完整临床及CT资料且经病理证实的鼻咽癌1100例.分析颈部淋巴结的表现,并对相关资料进行统计学处理.结果 1100例中1008例(91.64%)有颈部淋巴结转移,其中双侧转移656例(59.64%).咽后组淋巴结转移737例(67%),颈上深组转移973例(88.45%),颈后三角区转移367例(33.36%).CT扫描至相应部位发现有淋巴结转移者,颈中深组为630例(71.75%),颈下深组为200例(46.73%),锁骨上区为100例(30.96%).鼻咽癌可转移至颌下、颏下及腮腺内淋巴结,本组分别为93例(8.45%)、17例(1.55%)及38例(3.45%).转移淋巴结边缘规则614例(60.91%),边缘不规则394例(39.09%),其中明显侵犯周围结构者仅占70例(6.94%).增强CT扫描病例中98.50%的淋巴结为轻、中度强化,无强化及明显强化的淋巴结分别为0.69%和0.81%.转移淋巴结中50.60%密度均匀,49.40%内部密度不均匀,有低密度区,其中95例(9.42%)的淋巴结内有大片低密度坏死区,92例(9.13%)淋巴结内呈密度均匀一致的环状低密度区,且内壁规则.结论 鼻咽癌多发生颈部淋巴结转移,以咽后组与颈静脉链淋巴结多见.淋巴结边缘规则、增强后呈轻至中度强化、密度大致均匀为鼻咽癌淋巴结转移的典型表现.     

Cervical Castleman disease: CT study with angiographic correlation

The computed tomographic (CT) appearance, angiographic appearance, and clinical features of a patient with cervical Castleman disease, an uncommon disease of benign lymph node hyperplasia, are reported. CT scans showed a densely enhancing cervical mass. On external carotid angiography, the mass was seen as hypervascular with a capillary blush. Differential diagnosis included carotid body chemodectoma, vagal neuroma, tumor of the salivary gland, tuberculous adenitis and other granulomatous diseases, inflammatory lymph nodes, metastatic disease, and lymphoma.     

CT of renal lymphoma in children

OBJECTIVE: The purpose of this study was to determine the incidence and to describe the CT findings of renal lymphoma in children. CONCLUSION: Renal lymphoma was seen in 11 children, most commonly due to non-Hodgkin's lymphoma (n = 10, 91%) and Burkitt's subtype (n = 5, 45%). Multiple bilateral masses were the most common CT appearance. Less common presentations included focal solitary masses or an engulfing mass. Retroperitoneal lymph node enlargement and other organ involvements were common associated findings. Five of six patients with renal involvement at initial diagnosis have had cures or remissions. Therefore, renal involvement at the time of initial diagnosis with lymphoma does not portend a poor prognosis.     

胰周区域淋巴结CT表现及其解剖、病理基础

本文所述胰周淋巴结主要位于胰周围、肠系膜根部、门腔间隙和脾门。常见的淋巴结病变包括结核、淋巴瘤及转移性肿瘤。淋巴结结核CT强化表现为淋巴结增大，呈周边强化，易形成多房样征象。87．5％霍奇金病和70％非霍金奇淋巴瘤淋巴结增大呈均匀强化，少数呈均匀强化并坏死，解剖上优势地累及腹主动脉周围上、下部淋巴结。转移性肿瘤结增大强化特征与原发灶的细胞类以及有无化疗等相关，其优势解剖分布取决于原发肿瘤的淋巴引流途径。     

Computed tomography of the soft tissues of the neck. Lymph node metastases and their differential diagnosis. I. Methods and the principal CT criteria for lymph node metastases

Standardisation of the examination method is imperative to guarantee reproducible and valid assessability of the cervical lymph node status. To this end, update high-resolution CT equipment of the third generation will be suitable, provided it meets certain minimum requirements, such as: 120 kV, 280 mAs, 480 projections over 360 degrees, 4-5 mm slice thickness, continuous tomography. If a primary tumour is known to exist, no plain examination is needed. The decisive examination is effected after intravenous administration of contrast medium in a dosage of 2.0-2.5 ml contrast medium/kg body weight (assuming a body weight of 70 kg, this would amount to 150 ml = 45 g iodine), one-third of the total dosage to be given as bolus and two-thirds as a rapid infusion. This procedure ensures sharp definition of lymph nodes against vessels and musculature over the entire period of examination. If tumour anamnesis has been established the size of the lymph node is significant for assessing the lymph node status. Even lymph node metastases less than 15 mm can be properly identified if the structure of the lymph nodes is known and employed as a criterion (central hypodensity with rim enhancement, inhomogeneity).