Detailed nodal features of cervical tuberculous lymphadenitis on serial neck computed tomography before and after chemotherapy: Focus on the relation between clinical outcomes and computed tomography features

Objective: To investigate the relation between clinical outcomes and nodal features on computed tomography (CT) in cervical tuberculous lymphadenitis (CTBL) before and after antituberculous chemotherapy. Methods: Fifty-six patients with CTBL underwent CT before and after a 6- or 12-month course of standard chemotherapy. Three radiologists evaluated the nodal features on serial CT retrospectively, including calcification (no/punctuate/large), necrosis (no/eccentric/central), perinodal infiltrations (no/localized/extensive), and enhancing patterns (no/peripheral/homogeneous). The clinical outcome was defined as "favorable" (n = 33) or "unfavorable" (n = 23) at the completion of chemotherapy. Results: All the features on the initial CT scan did not show a statistically significant difference between the favorable and unfavorable groups. On the final CT scan, absence of necrosis (P < 0.005), no infiltration (P < 0.005), no enhancement (P < 0.008), and central enhancement (P < 0.014) were more common in the favorable group, whereas large necrosis (P < 0.005), localized and extensive infiltration (P = 0.005, P < 0.005), and peripheral enhancement were more common in the unfavorable group (P < 0.005, P = 0.009). Conclusions: Central necrosis, perinodal infiltration, and peripheral rim enhancement on the final CT scan showed differences between the 2 groups. These CT features reflecting inflammation can be useful findings for assessing treatment response.