Moon W K, Im J G, Yu I K, Lee S K, Yeon K M, Han M C
Department of Radiology, Seoul National University College of Medicine, Korea.
AJR Am J Roentgenol. 1996 Jan;166(1):21-5. doi: 10.2214/ajr.166.1.8571880.
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.
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.
Three imaging patterns of mediastinal tuberculous lymphadenitis (113 nodes) were seen of 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.
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.
本研究的目的是确定纵隔结核性淋巴结炎的磁共振成像表现，并将这些发现与临床和病理结果进行比较。
回顾性分析23例连续纵隔结核性淋巴结炎患者的磁共振图像，观察病变淋巴结的均匀性、信号强度以及注射对比剂后的强化情况（n = 19），并根据图像表现进行分组，与临床体征或症状以及病理结果（n = 9）进行相关性分析。
磁共振图像上可见纵隔结核性淋巴结炎的三种成像表现模式（113个淋巴结）。6例患者的淋巴结（1型，n = 25）相对均匀，在T1加权像和T2加权像上均高于肌肉信号，注射对比剂后均匀强化。这些患者有轻度（n = 2）或无（n = 4）全身症状。病理上，这些淋巴结对应于无坏死或仅有少量坏死的结核肉芽肿。14例患者的淋巴结（2型，n = 71）不均匀，注射对比剂后周边强化。强化区域在T1加权像上呈中等信号强度，在T2加权像上呈低信号，病理上对应于淋巴结内的周边肉芽组织；未强化区域在T1加权像上相对低信号，在T2加权像上明显高信号，病理上对应于淋巴结内的中央干酪样坏死或液化坏死。除1例2型淋巴结患者外，其余患者均有中度至重度临床体征和症状。其余3例患者的淋巴结（3型，n = 17）在T1加权像和T2加权像上均均匀低信号，注射对比剂后无强化。3型淋巴结患者均无临床体征或症状。病理上，这些淋巴结对应于纤维钙化性淋巴结。
纵隔结核性淋巴结炎最常见的磁共振成像表现为不均匀的淋巴结，在T2加权像上明显高信号，注射对比剂后周边强化。这种典型的磁共振成像表现多见于有严重症状的患者，是由于结核性淋巴结的干酪样坏死所致。
