Differentiating between Abdominal Tuberculous Lymphadenopathy and Lymphoma Using Multidetector Computed Tomography (MDCT) Sopa Pongpornsup MD*, Pannipa Eksamutchai MD*, Wanwarang Teerasamit MD*
* Department of Diagnostic Radiology Faculty of Medicine Siriraj Hospital Mahidol University, Bangkok, Thailand
Affiliation :
Objective : To evaluate the specific computed tomography (CT) imaging criteria for differentiating abdominal tuberculous
lymphadenopathy from lymphoma by using abdominal multidetector computed tomography (MDCT).
Material and Method: A retrospective review of 31 patients with abdominal tuberculous lymphadenopathy and 85 patients
with untreated lymphoma was conducted from abdominal CT scan reports in a single center, Siriraj Hospital, Mahidol
University, Bangkok Thailand. CT scan was independently reviewed by two expert radiologists who were blinded to the
patient’s history, treatment outcome, and final diagnosis. The anatomical site, anatomical distribution, CT enhancement
patterns, size of lymphadenopathy, amount and density of ascites, abdominal solid organ involvement, bowel involvement,
and lung involvement were recorded.
Results : MDCT showed that abdominal tuberculous lymphadenopathy involved predominately the mesenteric, upper and
lower para-aortic, periportal, and pancreaticoduodenal regions. Untreated lymphoma affected mainly the upper and lower
para-aortic, iliac, periportal, pancreaticoduodenal, and gastrohepatic regions. Mesenteric and periportal lymph nodes
were involved more often in patients with abdominal tuberculous lymphadenopathy than in those with untreated lymphoma
(p = 0.04). Iliac and inguinal lymph nodes were involved more often in patients with lymphoma than in those with tuberculosis
(p = 0.01). Anatomical distributions were significantly different between the two groups (p<0.01): confluence distribution
was noted more often in tuberculous lymphadenopathy. The enhancement patterns had significant difference between the
two groups. Peripheral enhancement was seen significantly more often in tuberculous lymphadenopathy, whereas
homogeneous enhancement was found more often in lymphoma. The maximum size of enlarged lymph nodes also showed
statistical difference between two groups by using t-test (p = 0.01). The mean diameters were 2.95 cm in tuberculous
lymphadenopathy and 4.10 cm in lymphoma. Ascites was found significantly more often in tuberculous lymphadenopathy
than in lymphoma (p = 0.03). However, the attenuation of ascites on pre-contrast images did not show statistical difference.
Small bowel and large bowel thickening were demonstrated more often in tuberculous lymphadenopathy than lymphoma
(p<0.01, p = 0.01), which mostly showed target sign enhancement in tuberculosis and homogeneous enhancement in
lymphoma. The presence of hepatomegaly and splenomegaly were not different between the two groups. The diagnostic
interpretations of two readers showed high sensitivity (93.5%) and high specificity (98.8% by reader1 and 97.6% by
reader 2).
Conclusion : The present study indicates that the anatomical site, anatomical distribution, enhancement patterns, and size
of lymphadenopathy, persistent ascites, and small and large bowel involvement seen on contrast-enhanced MDCT is useful
in differentiating between tuberculosis and untreated lymphomas.
Keywords : Tuberculosis, Tuberculous lymphadenopathy, Lymphoma, Multidetector computed tomography
