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Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease.

Ryoo I, Suh S, Lee YH, Seo HS, Seol HY - Korean J Radiol (2015)

Bottom Line: This study was approved by the Institutional Review Board.Finally, diagnostic accuracies were calculated using the independent findings.The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea.

ABSTRACT

Objective: Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases.

Materials and methods: This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings.

Results: The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease.

Conclusion: The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.

No MeSH data available.


Related in: MedlinePlus

40-year-old woman diagnosed with tuberculous lymphadenitis.A, B. Enlarged cervical lymph node shows gross internal necrosis and no definite echogenic hilum on gray-scale ultrasonography (A) and avascular pattern on power Doppler ultrasonography (B).
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Figure 3: 40-year-old woman diagnosed with tuberculous lymphadenitis.A, B. Enlarged cervical lymph node shows gross internal necrosis and no definite echogenic hilum on gray-scale ultrasonography (A) and avascular pattern on power Doppler ultrasonography (B).

Mentions: The size of a scanned lymph node was measured at the longest axis (long diameter) and the greatest diameter among the lines perpendicular to the long diameter (short diameter) on the same scan. Lymph node shape was assessed by the ratio of short diameter to long diameter. Conglomeration was defined as clustering of at least three lymph nodes resembling a bunch of grapes. Increased perinodal echogenicity was defined as increased echogenicity surrounding a lymph node compared to adjacent perinodal fat tissues (Figs. 1, 2). Internal necrosis was defined as a marked hypoechoic portion in the lymph node without color flow on the Doppler study; if the necrotic component was less than approximately one-fourth of the lymph node, it was considered to be a partially necrotic lymph node; otherwise it was considered a gross necrotic lymph node (Fig. 3). The vascular patterns of lymph nodes were evaluated using power Doppler US. Hilar vascular patterns were divided into three groups according to the location of the hilar vascular structures: normal, in which hilar vascular structures were seen as central or branching radially from the hilum in both longitudinal and transverse planes; displaced, in which hilar vascular structures were seen in eccentric or asymmetric locations; and avascular, in which no hilar vascularity was seen on power Doppler US.


Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease.

Ryoo I, Suh S, Lee YH, Seo HS, Seol HY - Korean J Radiol (2015)

40-year-old woman diagnosed with tuberculous lymphadenitis.A, B. Enlarged cervical lymph node shows gross internal necrosis and no definite echogenic hilum on gray-scale ultrasonography (A) and avascular pattern on power Doppler ultrasonography (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499540&req=5

Figure 3: 40-year-old woman diagnosed with tuberculous lymphadenitis.A, B. Enlarged cervical lymph node shows gross internal necrosis and no definite echogenic hilum on gray-scale ultrasonography (A) and avascular pattern on power Doppler ultrasonography (B).
Mentions: The size of a scanned lymph node was measured at the longest axis (long diameter) and the greatest diameter among the lines perpendicular to the long diameter (short diameter) on the same scan. Lymph node shape was assessed by the ratio of short diameter to long diameter. Conglomeration was defined as clustering of at least three lymph nodes resembling a bunch of grapes. Increased perinodal echogenicity was defined as increased echogenicity surrounding a lymph node compared to adjacent perinodal fat tissues (Figs. 1, 2). Internal necrosis was defined as a marked hypoechoic portion in the lymph node without color flow on the Doppler study; if the necrotic component was less than approximately one-fourth of the lymph node, it was considered to be a partially necrotic lymph node; otherwise it was considered a gross necrotic lymph node (Fig. 3). The vascular patterns of lymph nodes were evaluated using power Doppler US. Hilar vascular patterns were divided into three groups according to the location of the hilar vascular structures: normal, in which hilar vascular structures were seen as central or branching radially from the hilum in both longitudinal and transverse planes; displaced, in which hilar vascular structures were seen in eccentric or asymmetric locations; and avascular, in which no hilar vascularity was seen on power Doppler US.

Bottom Line: This study was approved by the Institutional Review Board.Finally, diagnostic accuracies were calculated using the independent findings.The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea.

ABSTRACT

Objective: Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases.

Materials and methods: This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings.

Results: The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease.

Conclusion: The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.

No MeSH data available.


Related in: MedlinePlus