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Current Concepts in Lymph Node Imaging^*

Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts

View larger version (138K): [in a new window]   FIGURE 1. US appearance of normal lymph node. Image shows flattened hypoechoic cigar-shaped structure (arrow).

View larger version (138K): [in a new window]   FIGURE 2. US appearance of malignant lymph node. Image shows enlarged round lymph node with mixed cystic and solid components in patient with metastatic papillary thyroid carcinoma.

View larger version (142K): [in a new window]   FIGURE 3. Benign node with fatty hilum. Contrast-enhanced axial image of lower abdomen shows 9-mm aortocaval node (arrow) with central fatty hilum.

View larger version (170K): [in a new window]   FIGURE 4. Axial T2-weighted image of lower abdomen shows 8-mm aortocaval node (arrow) with central fatty hilum (arrowhead).

View larger version (64K): [in a new window]   FIGURE 5. A 57-y-old woman with chest pain after lobectomy for lung cancer 4 mo earlier. (A) Axial CT scan shows mixed soft tissue and fluid in left pleural space. Prevascular and axillary lymph nodes were interpreted as normal. (B) Axial dual PET/CT scan shows increased uptake in soft-tissue mass as well as small prevascular and axillary lymph nodes, indicating recurrent disease with metastatic nodal spread.

View larger version (85K): [in a new window]   FIGURE 6. Bilateral paraaortic nodes in patient with known lymphoma, seen on PET but only unilaterally on CT. (A) Axial contrast-enhanced CT scan shows enlarged right paraaortic node (arrow). (B) Coronal PET image shows bilateral areas of intense uptake suggestive of bilateral paraaortic malignant nodes (arrows).

View larger version (60K): [in a new window]   FIGURE 7. A 62-y-old man with pancreatic cancer. (A) CT scan shows prominent periportal lymph node (arrow). (B) Node did not show increased 18F-FDG uptake. Cytology was positive for metastatic adenocarcinoma.

View larger version (40K): [in a new window]   FIGURE 8. A 41-y-old woman with breast cancer. (A) PET/CT scan shows abnormal increased metabolism in right posterior cervical lymph node (arrow). (B) Cancer was missed on CT scan when it was interpreted without PET information (arrow).

View larger version (61K): [in a new window]   FIGURE 9. Electron microscopy and modeling of ferumoxtran-10. (A and B) Electron micrographs of superparamagnetic hexagonal nanoparticle crystal measuring 3 nm on average (A, bar = 10 nm; B, bar = 1 nm). (C and D) Molecular model of surface-bound 10-kDa dextrans (overall mean particle size, 28 nm) and iron oxide crystal packing. (E) Mechanism of action. Systemically injected long circulating particles gain access to interstitium and are drained ubiquitously through lymphatic vessels. Lymph flow disturbances or disturbances of nodal architecture by metastases lead to abnormal accumulation patterns, detectable by MRI. (Reprinted with permission of (71).)

View larger version (145K): [in a new window]   FIGURE 10. Spectrum of nodal signal intensity changes with magnetic nanoparticles. (A–C) Normal lymph node in left iliac region on noncontrast MR image (A) and 24 h after intravenous administration of ferumoxtran-10 (arrow) (B). Note homogeneous decrease in signal intensity due to ferumoxtran-10 accumulation. (C) Corresponding histology (10x objective). (D–F) Nonenlarged iliac lymph node completely replaced by tumor (arrow). (D) Conventional MR image shows high-signal-intensity lymph node. (E) Twenty-four hours after ferumoxtran-10 administration. Note that nodal signal intensity remains high. (F) Corresponding histology. (G–I) Micrometasases in retroperitoneal node. (G) MR image shows high-signal-intensity lymph node. (H) Ferumoxtran-10–enhanced MR image demonstrates 2 hyperintense foci (arrows) within node corresponding to 2-mm metastases. (I) Corresponding histology confirms presence of adenocarcainoma within node. (Reprinted with permission of (71).)