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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

37-year-old man diagnosed with Kikuchi disease.A, B. Elongated cervical lymph node shows internal echogenic hilum (asterisk) and no definite necrotic component on gray-scale ultrasonography (A) and normal hilar vascular pattern on power Doppler ultrasonography (B).C. Axial computed tomography scan shows definite necrosis at same lymph node (arrow).
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Figure 4: 37-year-old man diagnosed with Kikuchi disease.A, B. Elongated cervical lymph node shows internal echogenic hilum (asterisk) and no definite necrotic component on gray-scale ultrasonography (A) and normal hilar vascular pattern on power Doppler ultrasonography (B).C. Axial computed tomography scan shows definite necrosis at same lymph node (arrow).

Mentions: However, a significantly smaller proportion of lymph nodes in the tuberculous lymphadenitis group had an echogenic hilum (24.7% [19/77] compared with 90.4% [122/135] in the Kikuchi disease group; p < 0.001) (Figs. 3, 4). The Kikuchi disease group showed a higher rate of posterior neck involvement (74.1% [100/135]) than that in the tuberculous lymphadenitis group (58.4% [45/77]; p = 0.028). Approximately 36.4% (28/77) of all lymph nodes in the tuberculous lymphadenitis group had internal calcification, whereas none of the lymph nodes in the Kikuchi disease group had internal calcification (p < 0.001) (Fig. 5). Furthermore, the internal necrosis patterns were significantly different between the two groups (p < 0.001) (Fig. 3). Fifty-five of 77 patients with tuberculous lymphadenitis (71.4%) had necrotic lymph nodes, and the majority of these (67.3% [37/55]) were gross necrotic nodes. In contrast, only 12 of 135 patients with Kikuchi disease (8.9%) had necrotic lymph nodes, and most of these (91.7% [11/12]) were partially necrotic.


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)

37-year-old man diagnosed with Kikuchi disease.A, B. Elongated cervical lymph node shows internal echogenic hilum (asterisk) and no definite necrotic component on gray-scale ultrasonography (A) and normal hilar vascular pattern on power Doppler ultrasonography (B).C. Axial computed tomography scan shows definite necrosis at same lymph node (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: 37-year-old man diagnosed with Kikuchi disease.A, B. Elongated cervical lymph node shows internal echogenic hilum (asterisk) and no definite necrotic component on gray-scale ultrasonography (A) and normal hilar vascular pattern on power Doppler ultrasonography (B).C. Axial computed tomography scan shows definite necrosis at same lymph node (arrow).
Mentions: However, a significantly smaller proportion of lymph nodes in the tuberculous lymphadenitis group had an echogenic hilum (24.7% [19/77] compared with 90.4% [122/135] in the Kikuchi disease group; p < 0.001) (Figs. 3, 4). The Kikuchi disease group showed a higher rate of posterior neck involvement (74.1% [100/135]) than that in the tuberculous lymphadenitis group (58.4% [45/77]; p = 0.028). Approximately 36.4% (28/77) of all lymph nodes in the tuberculous lymphadenitis group had internal calcification, whereas none of the lymph nodes in the Kikuchi disease group had internal calcification (p < 0.001) (Fig. 5). Furthermore, the internal necrosis patterns were significantly different between the two groups (p < 0.001) (Fig. 3). Fifty-five of 77 patients with tuberculous lymphadenitis (71.4%) had necrotic lymph nodes, and the majority of these (67.3% [37/55]) were gross necrotic nodes. In contrast, only 12 of 135 patients with Kikuchi disease (8.9%) had necrotic lymph nodes, and most of these (91.7% [11/12]) were partially necrotic.

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