Age-stratified Patterns of Thymic Involution on Multidetector CT

The aim of this study was to better assess the prevalence and appearance of thymic tissue in adults stratified by age using multidetector computed tomography (MDCT) in order to prevent misinterpretation of normal thymic tissue as pathology.

This study examined the CT appearance of the thymus in 597 trauma patients aged 30 to 69 years (M=48.0 y, SD=11.3). Three body fellowship-trained attending radiologists independently reviewed the CT scans. Reviewers assigned one of 5 grades on the basis of the relative proportions of fat and soft tissue in the thymic bed: complete fatty replacement (grade 0), predominantly fat (grade 1), even mix of soft tissue and fat (grade 2), predominantly soft tissue (grade 3), and discrete confluent thymic tissue (grade 4). Objectively, fixed-area region of interest values of the thymic bed were obtained. Interrater reliability was calculated.

Increased fatty replacement of the thymus occurred with increasing age. We found residual thymic tissue (≥grade 1) in the following age categories: 30 to 39 years (83.0%), 40 to 49 years (71.9%), 50 to 59 years (52.6%), and 60 to 69 years (34.8%). Kappa comparisons for the entire sample were excellent (κ=0.86). Higher grades had higher region of interest values.

Residual thymic tissue in adults on MDCT is both more prevalent and more prominent than that reported in earlier studies and can be visible into the seventh decade. We recommend that radiologists and clinicians familiarize themselves with the normal range appearances of the thymus on MDCT, in order to prevent misinterpretation of normal thymic tissue as pathology, which may result in unnecessary procedures.