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Kikuchi Cervical Lymphadenitis in Children: Ultrasound Differentiation From Common Infectious Lymphadenitis
Sunyoung Park1, Ji Young Kim1, Young Jin Ryu1
1Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Insights
Ultrasound features can help distinguish Kikuchi disease (KD) from infectious lymphadenitis in children. Homogeneous hypoechogenicity is a key indicator for KD, improving diagnostic accuracy when combined with other features like LN shape.
Area of Science:
- Radiology
- Pediatric Imaging
- Diagnostic Ultrasound
Background:
- Kikuchi disease (KD) is a rare, benign lymphadenopathy requiring accurate differentiation from infectious causes.
- Enlarged cervical lymph nodes (LNs) in pediatric patients necessitate precise diagnosis.
- Ultrasound (US) is a crucial imaging modality for evaluating cervical lymphadenopathy.
Purpose of the Study:
- To identify specific ultrasound (US) features that differentiate Kikuchi disease (KD) from common infectious lymphadenitis in East Asian pediatric patients.
- To assess the diagnostic accuracy of individual and combined US features for distinguishing KD.
Main Methods:
- Retrospective review of clinical, laboratory, and US data from 142 pediatric patients with KD and 45 with infectious lymphadenitis.
- Analysis of US features including pattern, laterality, size, location, shape, echogenicity, margin, hilum, necrosis, and perinodal changes.
- Receiver operating characteristic (ROC) curve analysis to determine diagnostic accuracy (Area Under the Curve - AUC).
Main Results:
- Significant US features differentiating KD included clustered adjacent pattern, bilaterality, even size, posterior neck involvement, elongated-to-ovoid shape, homogeneous hypoechogenicity, well-defined margins, echogenic fatty hilum, absence of necrosis, and increased perinodal fat echogenicity.
- Homogeneous hypoechogenicity demonstrated the highest univariate diagnostic accuracy (AUC 0.930).
- Combination models, particularly homogeneous echogenicity with LN shape or number of affected LNs, further improved diagnostic accuracy (AUC up to 0.949).
Conclusions:
- Homogeneous hypoechogenicity is a highly accurate univariate US feature for differentiating KD from infectious lymphadenitis in pediatric patients.
- Combining US features, specifically homogeneous hypoechogenicity with an elongated-to-ovoid shape, yields the highest diagnostic accuracy for KD.
Objectives:
To investigate ultrasound (US) features of enlarged cervical lymph nodes (LNs) to differentiate between Kikuchi disease (KD) and other common types of infectious lymphadenitis in an East Asian pediatric patient population.
Methods:
A total of 142 pediatric patients with KD and 45 patients with infectious lymphadenitis (suppurative lymphadenitis [n = 29], nontuberculous mycobacterial lymphadenitis [n = 9], and tuberculous lymphadenitis [n = 7]) were included. The clinical characteristics, laboratory results, and US features of LNs were reviewed. The area under the curve (AUC) from a receiver operating characteristic curve analysis was used as a diagnostic accuracy measure.
Results:
A multiple clustered adjacent pattern, bilaterality, an even size, posterior neck involvement, no enlargement, an elongated-to-ovoid shape, homogeneous hypoechogenicity, a well-defined margin, presence of an echogenic fatty hilum, no intranodal gross necrosis, increased perinodal fat echogenicity, and no increased echogenicity of the adjacent sternocleidomastoid muscle were significant US features of the affected LNs to discriminate KD from infectious lymphadenitis (P < .05). Homogeneous hypoechogenicity in KD showed the highest AUC (0.930) as a single variable (95% confidence interval, 0.88-0.96). The AUCs were increased in 3 combination models with 2 US features: homogeneous echogenicity and 1 of 3 other US features (increased perinodal fat echogenicity, 0.935; number of affected LNs, 0.947; and LN shape, 0.949).
Conclusions:
Homogeneous hypoechogenicity of LNs was a significant US feature with the highest diagnostic accuracy in differentiating KD from common infectious lymphadenitis on a univariate analysis. In the combination model, US features of an elongated-to-ovoid shape and homogeneous hypoechogenicity showed the highest diagnostic accuracy.
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