HEAD AND NECK RADIOLOGY / ORIGINAL PAPER
MRI and 18F-FDG-PET/CT findings of cervical reactive lymphadenitis: a comparison with nodal lymphoma
1
Department of Radiology, Gifu University, Gifu, Japan
2
Department of Pathology and Translational Research, Gifu University, Gifu, Japan
3
Department of Otolaryngology, Gifu University, Gifu, Japan
4
Department of Frontier Science for Imaging, Gifu University, Gifu, Japan
5
Department of Pharmacology, School of Medicine, Gifu University, Gifu, Japan
6
Centre for One Medicine Innovative Translational Research (COMIT), Gifu University, Gifu, Japan
Submission date: 2024-08-16
Final revision date: 2024-11-15
Acceptance date: 2024-11-29
Publication date: 2025-01-10
Corresponding author
Pol J Radiol, 2025; 90: 9-18
KEYWORDS
TOPICS
ABSTRACT
Purpose:
This study aimed to compare the findings of magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) to differentiate reactive lymphadenitis from nodal lymphoma of the head and neck.
Material and methods:
This study included 138 patients with histopathologically confirmed cervical lymphadenopathy, including 35 patients with reactive lymphadenitis and 103 patients with nodal lymphoma, who had neck MRI (n = 63) and/or 18F-FDG-PET/CT (n = 123) before biopsy. The quantitative and qualitative MRI results and maximum standardised uptake value (SUVmax) were retrospectively analysed and compared between the 2 pathologies.
Results:
The maximum diameter (22.4 ± 6.9 vs. 33.3 ± 16.0 mm, p < 0.01), minimum diameter (15.8 ± 3.6 vs. 22.3 ± 8.5 mm, p < 0.01), and SUVmax (6.9 ± 2.7 vs. 12.8 ± 8.0, p < 0.01) of the lesion were lower in reactive lymphadenitis than in nodal lymphoma, respectively. T2-hypointense-thickened capsules > 2 mm (46% vs. 14%, p < 0.05) and T2-hypointense areas converging to the periphery (15% vs. 0%, p < 0.05) were more frequently observed in reactive lymphadenitis than in nodal lymphoma, respectively. Hilum of nodes on T2-weighted images (54% vs. 22%, p < 0.05) and diffusion-weighted images (69% vs. 30%, p < 0.05) were more frequently demonstrated in reactive lymphadenitis than in nodal lymphoma, respectively.
Conclusions:
Reactive lymphadenitis had a smaller size and lower SUVmax. The presence of T2-hypointense-thickened capsules, T2-hypointense areas converging to the periphery, and hilum of nodes were signs of reactive lymphadenitis.
This study aimed to compare the findings of magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) to differentiate reactive lymphadenitis from nodal lymphoma of the head and neck.
Material and methods:
This study included 138 patients with histopathologically confirmed cervical lymphadenopathy, including 35 patients with reactive lymphadenitis and 103 patients with nodal lymphoma, who had neck MRI (n = 63) and/or 18F-FDG-PET/CT (n = 123) before biopsy. The quantitative and qualitative MRI results and maximum standardised uptake value (SUVmax) were retrospectively analysed and compared between the 2 pathologies.
Results:
The maximum diameter (22.4 ± 6.9 vs. 33.3 ± 16.0 mm, p < 0.01), minimum diameter (15.8 ± 3.6 vs. 22.3 ± 8.5 mm, p < 0.01), and SUVmax (6.9 ± 2.7 vs. 12.8 ± 8.0, p < 0.01) of the lesion were lower in reactive lymphadenitis than in nodal lymphoma, respectively. T2-hypointense-thickened capsules > 2 mm (46% vs. 14%, p < 0.05) and T2-hypointense areas converging to the periphery (15% vs. 0%, p < 0.05) were more frequently observed in reactive lymphadenitis than in nodal lymphoma, respectively. Hilum of nodes on T2-weighted images (54% vs. 22%, p < 0.05) and diffusion-weighted images (69% vs. 30%, p < 0.05) were more frequently demonstrated in reactive lymphadenitis than in nodal lymphoma, respectively.
Conclusions:
Reactive lymphadenitis had a smaller size and lower SUVmax. The presence of T2-hypointense-thickened capsules, T2-hypointense areas converging to the periphery, and hilum of nodes were signs of reactive lymphadenitis.
REFERENCES (18)
1.
Kaji AV, Mohuchy T, Swartz JD. Imaging of cervical lymphadenopathy. Semin Ultrasound CT MR 1997; 18: 220-249.
2.
Weiss LM, O’Malley D. Benign lymphadenopathies. Mod Pathol 2013; 26 Suppl 1: S88-S96. DOI: 10.1038/modpathol.2012.176.
3.
Slack GW. The pathology of reactive lymphadenopathies: a discussion of common reactive patterns and their malignant mimics. Arch Pathol Lab Med 2016; 140: 881-892.
4.
King AD, Lei KI, Ahuja AT. MRI of neck nodes in non-Hodgkin’s lymphoma of the head and neck. Br J Radiol 2004; 77: 111-115.
5.
Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 2006; 16: 1468-1477.
6.
Chen J, Xu D, Sun WJ, Wang WX, Xie NN, Ruan QR, et al. Differential diagnosis of lymphoma with (18)F-FDG PET/CT in patients with fever of unknown origin accompanied by lymphadenopathy. J Cancer Res Clin Oncol 2023; 149: 7187-7196.
7.
Som PM, Curtin HD, Mancuso AA. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol 2000; 174: 837-844.
8.
Weber AL, Rahemtullah A, Ferry JA. Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation. Neuroimaging Clin N Am 2003; 13: 371-392.
9.
Sumi M, Sakihama N, Sumi T, Morikawa M, Uetani M, Kabasawa H, et al. Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol 2003; 24: 1627-1634.
10.
King AD, Ahuja AT, Yeung DK, Fong DK, Lee YY, Lei KI, et al. Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging. Radiology 2007; 245: 806-813.
11.
Holzapfel K, Duetsch S, Fauser C, Eiber M, Rummeny EJ, Gaa J. Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 2009; 72: 381-387.
12.
Schrepfer T, Haerle SK, Strobel K, Schaefer N, Halg RA, Huber GF. The value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for staging of primary extranodal head and neck lymphomas. Laryngoscope 2010; 120: 937-944.
13.
Duvernay J, Schlund M, Majoufre C. Contribution of FDG-PET in the diagnostic assessment of cervical lymph node metastasis in Oral Cavity Squamous Cell Carcinoma (OCSCC). J Stomatol Oral Maxillofac Surg 2023; 124 (6S): 101659. DOI: 10.1016/j.jormas. 2023.101659.
14.
Ryu KH, Yoon S, Baek HJ, Kim TH, Moon JI, Choi BH, et al. Cervical lymph nodes detected by F-18 FDG PET/CT in oncology patients: added value of subsequent ultrasonography for determining nodal metastasis. Medicina (Kaunas) 2019; 56: 16. DOI: 10.3390/medicina56010016.
15.
He L, Chen Y, Tan X, Sun X, Zhang Q, Luo H, et al. (18)F-FDG PET/CT and contrast-enhanced CT in the diagnosis of Castleman disease. Jpn J Radiol 2023; 41: 98-107.
16.
Rehal S, Stephens M, Roizes S, Liao S, von der Weid PY. Acute small intestinal inflammation results in persistent lymphatic alterations. Am J Physiol Gastrointest Liver Physiol 2018; 314: G408-G417. DOI: 10.1152/ajpgi.00340.2017.
17.
Prativadi R, Dahiya N, Kamaya A, Bhatt S. Chapter 5 Ultrasound Characteristics of Benign vs Malignant Cervical Lymph Nodes. Semin Ultrasound CT MR 2017; 38: 506-515.
18.
Ahuja A, Ying M. Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol 2003; 58: 359-366.
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