Mediastinal tuberculous lymphadenitis: MR imaging appearance with clinicopathologic correlation

Woo Kyung Moon, Jung Gi Im, In Kyu Yu, Seon Kyu Lee, Kyung Mo Yeon, Man Chung Han

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. The purpose of our study was to determine the MR imaging appearance of mediastinal tuberculous lymphadenitis and to compare these findings with clinical and pathologic findings. MATERIALS AND METHODS. MR images of 23 consecutive patients with mediastinal tuberculous lymphadenitis were retrospectively analyzed with regard to homogeneity, signal intensity, and enhancement of diseased nodes after injection of contrast material (n = 19), and the imaging findings were grouped by patterns and correlated with clinical signs or symptoms and with pathologic (n = 9) findings. RESULTS. Three imaging patterns of mediastinal tuberculous lymphadenitis (113 nodes) were seen on MR images. In six patients, nodes (type 1, n = 25) were relatively homogeneous and hyperintense to muscle on both T1- and T2-weighted images and enhanced homogeneously after injection of contrast material. The patients had mild (n = 2) or no (n = 4) constitutional symptoms. The nodes corresponded pathologically to tuberculous granulomas without or with minimal necrosis. In 14 patients, nodes (type 2, n = 71) were inhomogeneous with a strong peripheral enhancement after injection of contrast material. Enhancing areas were of intermediate intensity on T1-weighted images and hypointense on T2-weighted images, and corresponded pathologically to peripheral granulation tissue within the nodes. Unenhanced areas were relatively hypointense on T1- weighted images and markedly hyperintense on T2-weighted images, and corresponded pathologically to central caseation or liquefaction necrosis within the nodes. All but one patient with type 2 nodes had moderate to severe clinical signs and symptoms. In the remaining three patients, nodes (type 3, n = 17) were homogeneously hypointense on both T1- and T2-weighted images and did not enhance after injection of contrast material. No patient with type 3 nodes had clinical signs or symptoms. The nodes corresponded pathologically to fibrocalcified nodes. CONCLUSION. The most common MR imaging appearance of mediastinal tuberculous lymphadenitis was as inhomogeneous nodes with marked hyperintensity on T2-weighted images and peripheral enhancement after injection of contrast material. This typical MR imaging appearance was mostly seen in severely symptomatic patients and was due to caseation necrosis of the tuberculous nodes.

Original languageEnglish (US)
Pages (from-to)21-25
Number of pages5
JournalAmerican Journal of Roentgenology
Volume166
Issue number1
DOIs
StatePublished - Jan 1996
Externally publishedYes

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Lymph Node Tuberculosis
Contrast Media
Injections
Signs and Symptoms
Necrosis
Image Enhancement
Granulation Tissue
Granuloma
Muscles

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Mediastinal tuberculous lymphadenitis : MR imaging appearance with clinicopathologic correlation. / Moon, Woo Kyung; Im, Jung Gi; Yu, In Kyu; Lee, Seon Kyu; Yeon, Kyung Mo; Han, Man Chung.

In: American Journal of Roentgenology, Vol. 166, No. 1, 01.1996, p. 21-25.

Research output: Contribution to journalArticle

Moon, Woo Kyung ; Im, Jung Gi ; Yu, In Kyu ; Lee, Seon Kyu ; Yeon, Kyung Mo ; Han, Man Chung. / Mediastinal tuberculous lymphadenitis : MR imaging appearance with clinicopathologic correlation. In: American Journal of Roentgenology. 1996 ; Vol. 166, No. 1. pp. 21-25.
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abstract = "OBJECTIVE. The purpose of our study was to determine the MR imaging appearance of mediastinal tuberculous lymphadenitis and to compare these findings with clinical and pathologic findings. MATERIALS AND METHODS. MR images of 23 consecutive patients with mediastinal tuberculous lymphadenitis were retrospectively analyzed with regard to homogeneity, signal intensity, and enhancement of diseased nodes after injection of contrast material (n = 19), and the imaging findings were grouped by patterns and correlated with clinical signs or symptoms and with pathologic (n = 9) findings. RESULTS. Three imaging patterns of mediastinal tuberculous lymphadenitis (113 nodes) were seen on MR images. In six patients, nodes (type 1, n = 25) were relatively homogeneous and hyperintense to muscle on both T1- and T2-weighted images and enhanced homogeneously after injection of contrast material. The patients had mild (n = 2) or no (n = 4) constitutional symptoms. The nodes corresponded pathologically to tuberculous granulomas without or with minimal necrosis. In 14 patients, nodes (type 2, n = 71) were inhomogeneous with a strong peripheral enhancement after injection of contrast material. Enhancing areas were of intermediate intensity on T1-weighted images and hypointense on T2-weighted images, and corresponded pathologically to peripheral granulation tissue within the nodes. Unenhanced areas were relatively hypointense on T1- weighted images and markedly hyperintense on T2-weighted images, and corresponded pathologically to central caseation or liquefaction necrosis within the nodes. All but one patient with type 2 nodes had moderate to severe clinical signs and symptoms. In the remaining three patients, nodes (type 3, n = 17) were homogeneously hypointense on both T1- and T2-weighted images and did not enhance after injection of contrast material. No patient with type 3 nodes had clinical signs or symptoms. The nodes corresponded pathologically to fibrocalcified nodes. CONCLUSION. The most common MR imaging appearance of mediastinal tuberculous lymphadenitis was as inhomogeneous nodes with marked hyperintensity on T2-weighted images and peripheral enhancement after injection of contrast material. This typical MR imaging appearance was mostly seen in severely symptomatic patients and was due to caseation necrosis of the tuberculous nodes.",
author = "Moon, {Woo Kyung} and Im, {Jung Gi} and Yu, {In Kyu} and Lee, {Seon Kyu} and Yeon, {Kyung Mo} and Han, {Man Chung}",
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T1 - Mediastinal tuberculous lymphadenitis

T2 - MR imaging appearance with clinicopathologic correlation

AU - Moon, Woo Kyung

AU - Im, Jung Gi

AU - Yu, In Kyu

AU - Lee, Seon Kyu

AU - Yeon, Kyung Mo

AU - Han, Man Chung

PY - 1996/1

Y1 - 1996/1

N2 - OBJECTIVE. The purpose of our study was to determine the MR imaging appearance of mediastinal tuberculous lymphadenitis and to compare these findings with clinical and pathologic findings. MATERIALS AND METHODS. MR images of 23 consecutive patients with mediastinal tuberculous lymphadenitis were retrospectively analyzed with regard to homogeneity, signal intensity, and enhancement of diseased nodes after injection of contrast material (n = 19), and the imaging findings were grouped by patterns and correlated with clinical signs or symptoms and with pathologic (n = 9) findings. RESULTS. Three imaging patterns of mediastinal tuberculous lymphadenitis (113 nodes) were seen on MR images. In six patients, nodes (type 1, n = 25) were relatively homogeneous and hyperintense to muscle on both T1- and T2-weighted images and enhanced homogeneously after injection of contrast material. The patients had mild (n = 2) or no (n = 4) constitutional symptoms. The nodes corresponded pathologically to tuberculous granulomas without or with minimal necrosis. In 14 patients, nodes (type 2, n = 71) were inhomogeneous with a strong peripheral enhancement after injection of contrast material. Enhancing areas were of intermediate intensity on T1-weighted images and hypointense on T2-weighted images, and corresponded pathologically to peripheral granulation tissue within the nodes. Unenhanced areas were relatively hypointense on T1- weighted images and markedly hyperintense on T2-weighted images, and corresponded pathologically to central caseation or liquefaction necrosis within the nodes. All but one patient with type 2 nodes had moderate to severe clinical signs and symptoms. In the remaining three patients, nodes (type 3, n = 17) were homogeneously hypointense on both T1- and T2-weighted images and did not enhance after injection of contrast material. No patient with type 3 nodes had clinical signs or symptoms. The nodes corresponded pathologically to fibrocalcified nodes. CONCLUSION. The most common MR imaging appearance of mediastinal tuberculous lymphadenitis was as inhomogeneous nodes with marked hyperintensity on T2-weighted images and peripheral enhancement after injection of contrast material. This typical MR imaging appearance was mostly seen in severely symptomatic patients and was due to caseation necrosis of the tuberculous nodes.

AB - OBJECTIVE. The purpose of our study was to determine the MR imaging appearance of mediastinal tuberculous lymphadenitis and to compare these findings with clinical and pathologic findings. MATERIALS AND METHODS. MR images of 23 consecutive patients with mediastinal tuberculous lymphadenitis were retrospectively analyzed with regard to homogeneity, signal intensity, and enhancement of diseased nodes after injection of contrast material (n = 19), and the imaging findings were grouped by patterns and correlated with clinical signs or symptoms and with pathologic (n = 9) findings. RESULTS. Three imaging patterns of mediastinal tuberculous lymphadenitis (113 nodes) were seen on MR images. In six patients, nodes (type 1, n = 25) were relatively homogeneous and hyperintense to muscle on both T1- and T2-weighted images and enhanced homogeneously after injection of contrast material. The patients had mild (n = 2) or no (n = 4) constitutional symptoms. The nodes corresponded pathologically to tuberculous granulomas without or with minimal necrosis. In 14 patients, nodes (type 2, n = 71) were inhomogeneous with a strong peripheral enhancement after injection of contrast material. Enhancing areas were of intermediate intensity on T1-weighted images and hypointense on T2-weighted images, and corresponded pathologically to peripheral granulation tissue within the nodes. Unenhanced areas were relatively hypointense on T1- weighted images and markedly hyperintense on T2-weighted images, and corresponded pathologically to central caseation or liquefaction necrosis within the nodes. All but one patient with type 2 nodes had moderate to severe clinical signs and symptoms. In the remaining three patients, nodes (type 3, n = 17) were homogeneously hypointense on both T1- and T2-weighted images and did not enhance after injection of contrast material. No patient with type 3 nodes had clinical signs or symptoms. The nodes corresponded pathologically to fibrocalcified nodes. CONCLUSION. The most common MR imaging appearance of mediastinal tuberculous lymphadenitis was as inhomogeneous nodes with marked hyperintensity on T2-weighted images and peripheral enhancement after injection of contrast material. This typical MR imaging appearance was mostly seen in severely symptomatic patients and was due to caseation necrosis of the tuberculous nodes.

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