Tuberculosis in the abdominal lymph nodes: evaluation with contrast-enhanced magnetic resonance imaging

To determine magnetic resonance imaging (MRI) characteristics of abdominal tuberculous lymphadenopathy.

Twenty-six consecutive patients (20 men, 6 women; mean age 38 ± 14 years) with documented tuberculosis (TB) in the abdominal lymph nodes were recruited and retrospectively analysed for contour, size, enhancement patterns, signal intensity and anatomic distribution of enlarged lymph nodes, as well as extra-nodal lesions.

The main anatomic distribution of lymph node involvement included the lesser omentum (80.8%, 21/26), anterior pararenal space (96.2%, 25/26), mesentery (34.6%, 9/26) and the upper para-aortic region (73.1%, 19/26), and, exceptionally, the lower para-aortic region (19.2%, 5/26). Contrast-enhanced T1-weighted images demonstrated predominantly peripheral enhancement in 24 cases (92.3%, 24/26), most of which (80.8%, 21/26) had enlarged lymph nodes with conglomerated multilocular appearance. In 24 peripheral enhancement cases, the contrast-to-noise ratio values were significantly higher for the marginal zones of the enlarged lymph nodes compared to the central zones in each contrast phase (all P < 0.05); the difference in signal-to-noise ratio between the central and marginal zones was found at the portal venous phase (P = 0.04).

The particular anatomic distribution and peripheral enhancement patterns of contrast-enhanced MRI with quantitative analysis might be useful in the diagnosis of abdominal tuberculous lymphadenopathy.