MRI of tuberculous cervical lymphadenopathy

The purpose of the study was to document the range of appearances of tuberculous cervical lymphadenopathy (TCL) on MRI.

The MR images of nine patients who were subsequently found to have TCL were retrospectively reviewed. All patients were scanned on a 1.5 T unit using a neck coil (nine patients) and a surface coil (five patients). Each abnormal region was assessed separately for maximum size, pattern of disease, necrosis, calcification, soft tissue edema, muscle involvement, and vascular compression.

There were 17 abnormal regions. The posterior triangle was most frequently involved (six patients) followed by the supraclavicular fossa (five patients). There were three patterns of disease, comprising discrete nodes, matted nodes, and confluent masses. Necrosis occurred in 10 of the 17 abnormal regions; necrotic areas were located peripherally in 7 of these 10. The percentage of necrotic to solid areas ranged from <25 to >75% and was not related to the pattern of disease. Edema was present in four patients and was seen with matted nodes and confluent masses. Muscle involvement and vascular compression occurred in three regions. Calcification was not identified.

MRI revealed three patterns of disease in TCL: discrete nodes, matted nodes, and confluent masses. Necrotic foci, when present, were more frequently peripheral rather than central, and this together with the soft tissue edema may be of value in differentiating TCL from metastatic nodes.