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Comparison of Silicosis and Tuberculosis Involving Mediastinal Lymph Nodes Based on Contrast-Enhanced Multidetector-Row Computed Tomography

  • IMAGING FEATURES OF SILICOSIS AND TUBERCULOSIS
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Abstract

Purpose

To investigate the different imaging features of contrast-enhanced multidetector-row-computed tomography (MDCT) for distinguishing between silicosis and tuberculosis involving the mediastinal lymph nodes.

Methods

86 silicosis patients and 61 tuberculosis patients with mediastinal lymphadenopathy based on contrast-enhanced MDCT were included. The enhanced patterns, anatomical distribution and calcification features of the enlarged lymph nodes were retrospectively compared between the groups using the Pearson chi-square test or Fisher’s exact test.

Results

Homogeneous enhancement of the mediastinal lymph nodes was more commonly observed in silicosis (94.2%, 81/86) than in tuberculosis (19.7%, 12/61). Peripheral enhancement was more frequent in tuberculosis (n = 44, 72.1%) than in silicosis involving the mediastinal lymph nodes (n = 1, 1.2%), and multilocular appearance was more frequent in TB than in silicosis. Tuberculosis was more likely to affect regions 1R, 2R, 2L, 3A, 5 and 6 than silicosis (all p < 0.05), especially region 2R. Calcification of the lymph nodes was more common in the silicosis group than in tuberculosis group. The sensitivity, specificity, and accuracy of silicosis with lymphadenopathy with homogeneous enhanced pattern were 94.2%, 80.3% and 88.4%, respectively. The sensitivity, specificity, and accuracy of tuberculosis lymphadenopathy with peripheral enhanced pattern were 72.1%, 98.8%, and 87.7%, respectively.

Conclusion

The predominant enhanced patterns, anatomical distribution, and calcification features of mediastinal lymph nodes were different between tuberculosis and silicosis. These radiographic features might help differentiate tuberculosis from silicosis, which provides imaging information for the differential diagnosis of the two diseases in a clinical setting.

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References

  1. Leung CC, Yu IT, Chen W (2012) Silicosis. Lancet (London, England) 379(9830):2008–2018. https://doi.org/10.1016/S0140-6736(12)60235-9

    Article  CAS  Google Scholar 

  2. The Lancet Respiratory Medicine (2019) The world is failing on silicosis. Lancet Respir Med 7(4):283. https://doi.org/10.1016/S0140-6736(12)60235-9

    Article  CAS  PubMed  Google Scholar 

  3. Rose C, Heinzerling A, Patel K et al (2019) Severe silicosis in engineered stone fabrication workers–California, Colorado, Texas, and Washington. MMWR 68(38):813–818. https://doi.org/10.15585/mmwr.mm6838a1

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nin CS, de Souza VV, do Amaral RH et al (2016) Thoracic lymphadenopathy in benign diseases: a state of the art review. Respir Med 112:10–17. https://doi.org/10.1016/j.rmed.2016.01.021

    Article  PubMed  Google Scholar 

  5. Pollard KM (2016) Silica, silicosis, and autoimmunity. Front Immunol 7:97. https://doi.org/10.3389/fimmu.2016.00097

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Furin J, Cox H, Pai M (2019) Tuberculosis. Lancet (London, England) 393(10181):1642–1656. https://doi.org/10.1016/S0140-6736(19)30308-3

    Article  Google Scholar 

  7. Floyd K, Glaziou P, Zumla A et al (2018) The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era. Lancet 6(4):299–314. https://doi.org/10.1016/S2213-2600(18)30057-2

    Article  Google Scholar 

  8. Dheda K, Barry CE 3rd, Maartens G (2016) Tuberculosis. Lancet (London, England) 387(10024):1211–1226. https://doi.org/10.1016/S0140-6736(15)00151-8

    Article  Google Scholar 

  9. Maji A, Misra R, Kumar Mondal A et al (2015) Expression profiling of lymph nodes in tuberculosis patients reveal inflammatory milieu at site of infection. Sci Rep 5:15214. https://doi.org/10.1038/srep15214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ (2019) Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics 39(7):2023–2037. https://doi.org/10.1148/rg.2019190109

    Article  PubMed  Google Scholar 

  11. Rusch VW, Asamura H, Watanabe H et al (2009) The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thoracic Oncol 4(5):568–577. https://doi.org/10.1097/JTO.0b013e3181a0d82e

    Article  Google Scholar 

  12. Yang ZG, Min PQ, Sone S et al (1999) Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast-enhanced CT. AJR Am J Roentgenol 172(3):619–623. https://doi.org/10.2214/ajr.172.3.10063847

    Article  CAS  PubMed  Google Scholar 

  13. Shao H, Yang ZG, Xu GH et al (2013) Tuberculosis in the abdominal lymph nodes: evaluation with contrast-enhanced magnetic resonance imaging. Int J Tuberc Lung Dis 17(1):90–95. https://doi.org/10.5588/ijtld.12.0115

    Article  CAS  PubMed  Google Scholar 

  14. Jacobson G, Felson B, Pendergrass EP et al (1967) Eggshell calcifications in coal and metal miners. Emin Roentgenol 2(3):276–282. https://doi.org/10.1016/0037-198x(67)90015-6

    Article  Google Scholar 

  15. Taeger D, Brüning T, Pesch B et al (2011) Association between lymph node silicosis and lung silicosis in 4,384 German uranium miners with lung cancer. Arch Environ Occup Health 66(1):34–42

    Article  CAS  Google Scholar 

  16. Seal RM, Cockcroft A, Kung I et al (1986) Central lymph node changes and progressive massive fibrosis in coalworkers. Thorax 41(7):531–537. https://doi.org/10.1136/thx.41.7.531

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Cox-Ganser JM, Burchfiel CM, Fekedulegn D et al (2009) Silicosis in lymph nodes: the canary in the miner? J Occup Environ Med 51(2):164–169. https://doi.org/10.1097/JOM.0b013e31818f6a0f

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kang W, Yu J, Du J et al (2020) The epidemiology of extrapulmonary tuberculosis in China: a large scale multi-center observational study. PLoS ONE 15(8):23-e0237753. https://doi.org/10.1371/journal.pone.0237753

    Article  CAS  Google Scholar 

  19. Garn H, Friedetzky A, Kirchner A et al (2000) Experimental silicosis: a shift to a preferential IFN-gamma-based Th1 response in thoracic lymph nodes. Am J Physiol Lung Cell Mol Physiol 278(6):L1221–L1230. https://doi.org/10.1152/ajplung.2000.278.6.L1221

    Article  CAS  PubMed  Google Scholar 

  20. Luo MY, Liu L, Lai LS et al (2010) Deepgoing study on intrathoracic tuberculous lymphadenitis in adults using multidetector CT. Chin Med J (Engl) 123(10):1283–1288. https://doi.org/10.3760/cma.j.issn.0366-6999.2010.10.011

    Article  Google Scholar 

  21. Moon WK, Im JG, Yeon KM et al (1998) Mediastinal tuberculous lymphadenitis: CT findings of active and inactive disease. AJR Am J Roentgenol 170(3):715–718. https://doi.org/10.2214/ajr.170.3.9490959

    Article  CAS  PubMed  Google Scholar 

  22. Tang SS, Yang ZG, Deng W et al (2012) Differentiation between tuberculosis and lymphoma in mediastinal lymph nodes: evaluation with contrast-enhanced MDCT. Clin Radiol 67(9):877–883. https://doi.org/10.1016/j.crad.2012.02.006

    Article  PubMed  Google Scholar 

  23. Riquet M, Rivera C, Pricopi C et al (2015) Is the lymphatic drainage of lung cancer lobe-specific? A surgical appraisal. Eur J Cardio-Thoracic Surg 47(3):543–549

    Article  Google Scholar 

  24. Ghesani N, Patrawalla A, Lardizabal A et al (2014) Increased cellular activity in thoracic lymph nodes in early human latent tuberculosis infection. Am J Respir Crit Care Med 189(6):748–750

    Article  Google Scholar 

  25. Fourdrain A, Lafitte S, Iquille J et al (2018) Lymphatic drainage of lung segments in the visceral pleura: a cadaveric study. Surg Radiol Anat 40(1):15–19. https://doi.org/10.1007/s00276-017-1910-3

    Article  PubMed  Google Scholar 

  26. de Miranda Félix RH, de Castro Pereira CA (2015) Eggshell calcification of lymph nodes in silicosis. Am J Med Sci 350(4):320. https://doi.org/10.1097/MAJ.0000000000000302

    Article  PubMed  Google Scholar 

  27. Marchiori E, Hochhegger B, Zanetti G (2018) Lymph node calcifications. Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 44(2):83. https://doi.org/10.1590/s1806-37562018000000003

    Article  Google Scholar 

  28. Liu X, Yang ZG, Tang SS et al (2014) Characteristics of mediastinal lymph nodes enlargement determined by contrast-enhanced multi-detector CT in patients with sarcoidosis. Sichuan da xue xue bao. Yi xue ban 45(2):281–283

    PubMed  Google Scholar 

  29. Zhang S, Yang ZG, Liu X et al (2014) Tuberculosis vs. chronic lymphocytic leukaemia in mediastinal lymph nodes using computed tomography. Int J Tuberc Lung Dis 18(2):211–215. https://doi.org/10.5588/ijtld.13.0500

    Article  CAS  PubMed  Google Scholar 

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Funding

This work was not supported by any external funding.

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Author notes

  1. **ao-Ling Wen and Rui Shi have contributed equally to this work and should be considered as the equal first authors.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue **ang, Chengdu, 610041, Sichuan, China

    **ao-Ling Wen, Rui Shi, Yuan Li, Yi Shu & Zhi-Gang Yang

  2. Department of Radiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    **ao-Ling Wen, **an-Chao Yu & Qian-Chi Yu

  3. Department of Radiology, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China

    Ying-Kun Guo

  4. Department of Radiology, Chengdu Fifth People’s Hospital, Chengdu, 611100, Sichuan, China

    Si-Shi Tang

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Correspondence to Zhi-Gang Yang.

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All authors have approved this version of the article, and we stated as follows: (1) this manuscript has not been published before. (2) this manuscript is not under consideration for publication anywhere else; (3) there are no conflicts of interest to declare. (4) This study was a retrospective analysis and was approved by the Biomedical Research Ethics Committee of our institution. The sensitive information of patients was protected with confidentiality and was only used for this retrospective study. (5) The publisher will not be held legally responsible should there be any claims for compensation.

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Wen, XL., Shi, R., Guo, YK. et al. Comparison of Silicosis and Tuberculosis Involving Mediastinal Lymph Nodes Based on Contrast-Enhanced Multidetector-Row Computed Tomography. Lung 200, 261–268 (2022). https://doi.org/10.1007/s00408-022-00522-5

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