Abstract
PurposeTo evaluate the feasibility of quantitative analysis of chest computed tomography (CT) scans for the assessment of lymph node (LN) involvement in patients with pulmonary tuberculosis and sarcoidosis.MethodsIn 47 patients with tuberculosis (n = 26) or sarcoidosis (n = 21), 115 lymph nodes (tuberculous, 55; sarcoid, 60) were visually analyzed on chest CT scans according to their size, location, attenuation and shape. Each node was manually segmented using image analysis tool, which was quantitatively analyzed using the following variables: Feret’s diameter, perimeter, area, circularity, mean grey value (Mean), standard deviation (SD) of grey value, minimum grey value (Min), maximum grey value (Max), median grey value (Median), skewness, kurtosis, and net enhancement. We statistically analyzed the visual and quantitative CT features of tuberculous and sarcoid LNs.ResultsIn visual CT analysis, the mean node size in sarcoidosis was significantly greater than that in tuberculosis. There were no statistical differences between tuberculous and sarcoid LNs in terms of location and shape. Central low attenuation and peripheral rim enhancement were more frequently observed in tuberculous LNs than in the sarcoid ones. In quantitative CT analysis, there were significant differences in the values of the Feret’s diameter, perimeter, area, circularity, mean grey value, SD, median, skewness, and kurtosis between tuberculous and sarcoid LNs.ConclusionsQuantitative CT analysis using CT parameters with pixel-by-pixel measurements can help to differentiate of tuberculous and sarcoid LNs.
Highlights
Granulomatous lymphadenitis can be classified into infectious and non-infectious types
Central low attenuation and peripheral rim enhancement were more frequently observed in tuberculous lymph node (LN) than in the sarcoid ones
Tuberculous lymphadenitis is characterized as presenting low attenuation as well as peripheral rim enhancement on computed tomography (CT) images
Summary
Granulomatous lymphadenitis can be classified into infectious and non-infectious types. Sarcoidosis is a systemic disease that most commonly affects intrathoracic lymph nodes. It presents non-caseating granuloma as a characteristic feature, and its exact etiology is unknown. Tuberculous lymphadenitis is characterized as presenting low attenuation as well as peripheral rim enhancement on computed tomography (CT) images. The CT findings of lymph node involvement present as bilateral, symmetric enlargement of the hilar and right paratracheal lymph nodes and relatively uniform contrast enhancement. These two diseases can be distinguished pathologically on the basis of the presence of central caseating necrosis. Radiographic differentiation of the two diseases is not often clear and easy because central caseating necrosis is not always visualized on CT images
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