MRI and F-FDG-PET/CT Findings of Cervical Reactive Lymphadenitis: a Comparison with Nodal Lymphoma

Overview

Journal Pol J Radiol

Publisher Termedia

Specialty Radiology

Date 2025 Mar 12

PMID 40070419

Authors

Hiroki Kato

Tomohiro Ando

Yusuke Kito

Hirofumi Shibata

Takenori Ogawa

Takuya Seko

Masaya Kawaguchi

Yoshifumi Noda

Fuminori Hyodo

Masayuki Matsuo

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aimed to compare the findings of magnetic resonance imaging (MRI) and F-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 ( = 63) and/or F-FDG-PET/CT ( = 123) before biopsy. The quantitative and qualitative MRI results and maximum standardised uptake value (SUV) were retrospectively analysed and compared between the 2 pathologies.

Results: The maximum diameter (22.4 ± 6.9 vs. 33.3 ± 16.0 mm, < 0.01), minimum diameter (15.8 ± 3.6 vs. 22.3 ± 8.5 mm, < 0.01), and SUV (6.9 ± 2.7 vs. 12.8 ± 8.0, < 0.01) of the lesion were lower in reactive lymphadenitis than in nodal lymphoma, respectively. T2-hypointense-thickened capsules > 2 mm (46% vs. 14%, < 0.05) and T2-hypointense areas converging to the periphery (15% vs. 0%, < 0.05) were more frequently observed in reactive lymphadenitis than in nodal lymphoma, respectively. Hilum of nodes on T2-weighted images (54% vs. 22%, < 0.05) and diffusion-weighted images (69% vs. 30%, < 0.05) were more frequently demonstrated in reactive lymphadenitis than in nodal lymphoma, respectively.

Conclusions: Reactive lymphadenitis had a smaller size and lower SUV. The presence of T2-hypointense-thickened capsules, T2-hypointense areas converging to the periphery, and hilum of nodes were signs of reactive lymphadenitis.

References

Chen J, Xu D, Sun W, Wang W, Xie N, Ruan Q . Differential diagnosis of lymphoma with F-FDG PET/CT in patients with fever of unknown origin accompanied by lymphadenopathy. J Cancer Res Clin Oncol. 2023; 149(10):7187-7196. PMC: 10374793. DOI: 10.1007/s00432-023-04665-7. View

Rehal S, Stephens M, Roizes S, Liao S, von der Weid P . Acute small intestinal inflammation results in persistent lymphatic alterations. Am J Physiol Gastrointest Liver Physiol. 2018; 314(3):G408-G417. DOI: 10.1152/ajpgi.00340.2017. View

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(5):506-515. DOI: 10.1053/j.sult.2017.05.005. View

Slack G . The Pathology of Reactive Lymphadenopathies: A Discussion of Common Reactive Patterns and Their Malignant Mimics. Arch Pathol Lab Med. 2016; 140(9):881-92. DOI: 10.5858/arpa.2015-0482-SA. View

Holzapfel K, Duetsch S, Fauser C, Eiber M, Rummeny E, Gaa J . Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol. 2008; 72(3):381-7. DOI: 10.1016/j.ejrad.2008.09.034. View

Weber A, Rahemtullah A, Ferry J . Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation. Neuroimaging Clin N Am. 2003; 13(3):371-92. DOI: 10.1016/s1052-5149(03)00039-x. View

Kaji A, Mohuchy T, Swartz J . Imaging of cervical lymphadenopathy. Semin Ultrasound CT MR. 1997; 18(3):220-49. DOI: 10.1016/s0887-2171(97)90021-4. View

Ahuja A, Ying M . Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol. 2003; 58(5):359-66. DOI: 10.1016/s0009-9260(02)00585-8. View

Schrepfer T, Haerle S, Strobel K, Schaefer N, Halg R, Huber G . The value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for staging of primary extranodal head and neck lymphomas. Laryngoscope. 2010; 120(5):937-44. DOI: 10.1002/lary.20843. View

10.

Sumi M, Sakihama N, Sumi T, Morikawa M, Uetani M, Kabasawa H . Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol. 2003; 24(8):1627-34. PMC: 7974010. View

11.

King A, Ahuja A, Yeung D, Fong D, Lee Y, Lei K . Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging. Radiology. 2007; 245(3):806-13. DOI: 10.1148/radiol.2451061804. View

12.

King A, Lei K, Ahuja A . MRI of neck nodes in non-Hodgkin's lymphoma of the head and neck. Br J Radiol. 2004; 77(914):111-5. DOI: 10.1259/bjr/53555208. View

13.

Weiss L, OMalley D . Benign lymphadenopathies. Mod Pathol. 2013; 26 Suppl 1:S88-96. DOI: 10.1038/modpathol.2012.176. View

14.

Som P, Curtin H, Mancuso A . Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol. 2000; 174(3):837-44. DOI: 10.2214/ajr.174.3.1740837. View

15.

He L, Chen Y, Tan X, Sun X, Zhang Q, Luo H . F-FDG PET/CT and contrast-enhanced CT in the diagnosis of Castleman disease. Jpn J Radiol. 2022; 41(1):98-107. DOI: 10.1007/s11604-022-01318-6. View

16.

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. View

17.

Razek A, Soliman N, Elkhamary S, Alsharaway M, Tawfik A . Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 2006; 16(7):1468-77. DOI: 10.1007/s00330-005-0133-x. View

18.

Ryu K, Yoon S, Baek H, Kim T, Moon J, Choi B . Cervical Lymph Nodes Detected by F-18 FDG PET/CT in Oncology Patients: Added Value of Subsequent Ultrasonography for Determining Nodal Metastasis. Medicina (Kaunas). 2020; 56(1). PMC: 7022812. DOI: 10.3390/medicina56010016. View