The significance of necrotic mediastinal lymph nodes on CT in patients with newly diagnosed Hodgkin disease

AJR. American Journal of Roentgenology
K D HopperM A McCauslin

Abstract

Necrosis in lymph nodes shown on CT in many patients with nodal metastases may indicate that the primary tumor is aggressive and has a high degree of malignancy. However, the significance of nodal necrosis in patients with mediastinal Hodgkin disease remains uncertain. We studied the thoracic CT scans of 76 patients who had newly diagnosed Hodgkin disease with mediastinal involvement with respect to the presence of necrosis (low attenuation, complex, fluidlike areas), the size and volume of the mass, the sites involved, extension ("E" disease), and the patients' clinical response to treatment. CT scans showed necrotic nodes in 16 patients (21%). The difference between these patients and those without necrotic nodes was not statistically significant with respect to sex, age, stage, distribution of disease, presence of E disease, cell type, mass diameter, or the presence of bulk disease (mass diameter/maximal thoracic diameter greater than or equal to 0.33). The mass volume as measured by CT was not significantly (p = .08) larger (1274 cm3) than the group without necrotic nodes (876 cm3). An analysis of the various mediastinal sites involved showed no difference between patients with and without necrotic nodes. Lastly, the presen...Continue Reading

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