Kikuchi Disease: Differentiation from Tuberculous Lymphadenitis Based on Patterns of Nodal Necrosis on CT

Lee, S.; Yoo, Jeong Hyun; Lee, S. W.

doi:10.3174/ajnr.a2724

Cited by 31 publications

(38 citation statements)

References 15 publications

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“…However the natural course and the therapeutic methods for each are completely different. The treatment for TL usually consists of anti-tuberculosis medication and occasional surgical removal [2,6]. KD is self-contained and the lymphadenitis resolves within one to four months [1,6].…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of KD is still unknown, but some reports suggest that viral infections or autoimmune diseases may be the causes [1,2]. KD is a benign form of lymphadenitis and spontaneously recovers within weeks to months, so an exact assessment is important to avoid unnecessary procedures and management [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…Typical CT findings of KD are multiple, enlarged lymph nodes with commonly unilateral cervical distributions at levels II–V of the cervical neck, and homogenous enhancement with perinodal infiltration, but these have been nonspecific [4]. Nodal necrosis with heterogeneous attenuation is atypical and with mildly indistinct margins, multiple necrotic foci and a high attenuation of necrotic foci are associated with KD [2]. However, KD mimics other forms of benign lymphadenopathy, such as RH and TL.…”

Section: Introductionmentioning

confidence: 99%

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CT pattern analysis of necrotizing and nonnecrotizing lymph nodes in Kikuchi disease

et al. 2017

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ObjectiveThe purpose of this study was to determine whether a CT interpretation with imaging pattern analysis differentiates Kikuchi disease (KD) from the two more frequently encountered differential lymph nodes diagnoses of tuberculous lymphadenopathy (TL) and reactive hyperplasia (RH).Materials and methodsBetween January 2012 and July 2015, 20 patients with KD (6 men, 14 women; mean age, 27.80 years), 36 patients with RH (10 men, 26 women; mean age, 33.08 years) and 34 patients with TL (17 men, 17 women; mean age, 39.82 years) were pathologically diagnosed using US-guided fine needle aspiration biopsy, core needle biopsy, or surgical excisional biopsy. We recorded the total number, location, and size of the affected cervical lymph nodes, and two radiologists reviewed the characteristic imaging findings, including the presence of necrosis, cortical enhancement pattern, perinodal infiltration, conglomeration and nodal calcification, to form a consensus. In addition, we compared two attenuation indices on the nonnecrotic portion of the affected lymph nodes, nodal cortical attenuation (NCA) and the ratio of NCA to the adjacent muscle (NCA/M).ResultsConglomeration, enhancement pattern and NCA/M values were independent predictive CT features to distinguish KD from RH. Age and enhancement pattern discriminated KD from TL. Only the mean NCA/M value was a statistically significant CT feature (p = .008) in differentiating KD from both RH+TL. The mean NCA/M of KD (1.67 ± 0.20) was significantly higher than that of RH (1.49 ± 0.20) or TL (1.47 ± 0.21).ConclusionOur results indicate that in case of nonnecrotic lymphadenopathy, a higher NCA/M index can differentiate KD from RH and TL. In addition, the enhancement pattern according to the degree of necrosis discriminated between KD and TL in the case of necrotic lymphadenopathy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CT pattern analysis of necrotizing and nonnecrotizing lymph nodes in Kikuchi disease

et al. 2017

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“…The enhanced features of metastatic lymph nodes from different pathology of primary tumors showed different under MSCT scanning, usually displaying as ring-shaped and thin-wall enhancement. Meanwhile, lymph nodes from tuberculosis necrotizing lymphadenitis show heterogeneous enhancement with thick edge (Lee et al, 2012). So, MSCT is able to diagnose lymph node metastasis.…”

Section: Discussionmentioning

confidence: 99%

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

Tan

Yao²,

Huang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (18), 7719-7724 IntroductionEsophageal cancer is the ninth malignant tumor in death in the world. There is an average of 150, 000 people died of esophageal cancer every year and ranked forth in China. The 5-year survival rate is less than 10% for patients suffering from esophageal cancer, and showed poor prognosis. The reason may be due to that the majority of patients have been diagnosed as advanced when perceived, and full-thickness esophageal wall has been involved or lymph node metastasis and distant metastasis has occurred. Lymph node metastasis and metastatic numbers are believed as dependent negative AbstractBackground: Lymph node metastasis is believed to be a dependent negative prognostic factor of esophageal cancer. To explore detection methods with high sensitivity and accuracy for metastases to regional and distant lymph nodes in the clinic is of great significance. This study focused on clinical application of FDG PET/CT and contrast-enhanced multiple-slice helical computed tomography (MSCT) in lymph node staging of esophageal cancer. Materials and Methods: One hundred and fifteen cases were examined with enhanced 64-slice-MSCT scan, and FDG PET/CT imaging was conducted for neck, chest and upper abdomen within one week. The primary lesion, location and numbers of metastatic lymph nodes were observed. Surgery was performed within one week after FDG PET/CT detection. All resected lesions were confirmed histopathologically as the gold standard. Comparative analysis of the sensitivity, specificity, and accuracy based on FDG PET/CT and MSCT was conducted. Results: There were 946 lymph node groups resected during surgery from 115 patients, and 221 were confirmed to have metastasis pathologically. The sensitivity, specificity, accuracy of FDG PET/CT in detecting lymph node metastasis were 74.7%, 97.2% and 92.0%, while with MSCT they were 64.7%, 96.4%, and 89.0%, respectively. A significance difference was observed in sensitivity (p=0.030), but not the others (p>0.05). The accuracy of FDG PET/CT in detecting regional lymph node with or without metastasis were 91.9%, as compared to 89.4% for MSCT, while FDG PET/CT and MSCT values for detecting distant lymph node with or without metastasis were 94.4% and 94.7%. No significant difference was observed for either regional or distant lymph node metastasis. Additionally, for detecting para-esophageal lymph nodes metastasis, the sensitivity of FDG PET/CT was 72%, compared with 54.7% for MSCT (p=0.029). Conclusions: FDG PET/CT is more sensitive than MSCT in detecting lymph node metastasis, especially for para-esophageal lymph nodes in esophageal cancer cases, although no significant difference was observed between FDG PET/CT and MSCT in detecting both regional and distant lymph node metastasis. However, enhanced MSCT was found to be of great value in distinguishing false negative metastatic lymph nodes from FDG PET/CT. The combination of FDG PET/CT with MSCT should improve the accuracy in lymph node metastasis staging of esophageal cancer.

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“…other hand, KFD is more prevalent among women and besides, extremely rare in Iran with only one reported case (12). Moreover, extensive necrosis and size of the lymph nodes were not typical for KFD (13).…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Diffuse Large B-cell Lymphoma Masquerading as Necrotizing Lymph Nodes: The Role of Core Needle Biopsy for Early Diagnosis

et al. 2018

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Introduction: Complete lymph node necrosis is a rare condition. Excisional biopsy of infarcted lymph node could wrongly lead physicians to benign diagnoses such as Kikuchi-Fujimoto disease, while malignant lymphoma progresses. Case Presentation: A 33-year-old man was referred with gradual enlargement of a left submandibular mass which had recently become painful. The patient had no dysphagia, odynophagia, dysphonia, dyspnea, coughing, nasal obstruction, tooth ache or epistaxis. Three masses were detected by physical examination and computed tomography. There were no signs of malignancy in fine needle aspiration and excisional biopsy. The patient was finally diagnosed by core needle biopsy under ultrasonography guidance and a second excisional biopsy. Conclusions:The core needle biopsy under ultrasonography guidance could help choosing the optimal lymph node among multiple necrotizing lymph nodes and would prevent more invasive procedures. We emphasize that physicians should keep a high clinical suspicion for lymphoma even if the initial excisional biopsy of an infarcted lymph node is negative.

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Kikuchi Disease: Differentiation from Tuberculous Lymphadenitis Based on Patterns of Nodal Necrosis on CT

Cited by 31 publications

References 15 publications

CT pattern analysis of necrotizing and nonnecrotizing lymph nodes in Kikuchi disease

CT pattern analysis of necrotizing and nonnecrotizing lymph nodes in Kikuchi disease

Combination of FDG PET/CT and Contrast-Enhanced MSCT in Detecting Lymph Node Metastasis of Esophageal Cancer

A Case Report of Diffuse Large B-cell Lymphoma Masquerading as Necrotizing Lymph Nodes: The Role of Core Needle Biopsy for Early Diagnosis

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