title: Comparison of Ultrasonographic Findings of Biopsy-Proven Tuberculous Lymphadenitis and Kikuchi Disease.
abstract: OBJECTIVE
  Although tuberculous lymphadenitis and Kikuchi disease are common causes of cervical lymphadenopathy in Asians and exhibit similar clinical manifestations, their treatment strategies are totally different. The purpose of this study was to identify ultrasonographic features that distinguish these two diseases.
  
  
  METHODS
  This study was approved by the Institutional Review Board. The study included 77 patients with tuberculous lymphadenitis and 135 patients with Kikuchi disease. The sex and age distributions of the patients were analyzed. The size and shape of lymph nodes (LNs), presence of conglomeration, increased perinodal echogenicity, echogenic hilum, posterior neck involvement, internal calcification, patterns of internal necrosis, laterality of involved LNs, and hilar vascular patterns on ultrasonography were compared between the two groups. Multiple logistic regression analysis was conducted to identify independent findings to discriminate tuberculous lymphadenitis from Kikuchi disease. Finally, diagnostic accuracies were calculated using the independent findings.
  
  
  RESULTS
  The presence of an echogenic hilum, internal calcification, patterns of internal necrosis, and LN hilar vascular structures on power Doppler ultrasonography were independent findings that discriminated tuberculous lymphadenitis from Kikuchi disease. The diagnostic accuracy of each of these four factors was 84.9% (181/212), 76.9% (163/212), 84% (178/212), and 89.2% (189/212), respectively. A combination of internal calcification and hilar vascular structures showed the best accuracy of 89.6% (190/212) (sensitivity, 86.7% [117/135]; specificity, 94.8% [73/77]) for diagnosing Kikuchi disease.
  
  
  CONCLUSIONS
  The presence of an echogenic hilum, internal calcification, pattern of internal necrosis, and LN hilar vascular structures are useful ultrasonographic findings to differentiate tuberculous lymphadenitis from Kikuchi disease.
authors.affiliation: Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea.
authors.forename: Inseon
authors.initials: I
authors.lastname: Ryoo
authors.affiliation: Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea.
authors.forename: Sangil
authors.initials: S
authors.lastname: Suh
authors.affiliation: Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 425-707, Korea.
authors.forename: Young Hen
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Radiology, Ansan Hospital, Korea University College of Medicine, Ansan 425-707, Korea.
authors.forename: Hyung Suk
authors.initials: HS
authors.lastname: Seo
authors.affiliation: Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul 152-703, Korea.
authors.forename: Hae Young
authors.initials: HY
authors.lastname: Seol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D001706:Biopsy; D002114:Calcinosis / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D020042:Histiocytic Necrotizing Lymphadenitis / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D009336:Necrosis / Q000473:pathology; D012680:Sensitivity and Specificity; D014388:Tuberculosis, Lymph Node / Q000000981:diagnostic imaging* / Q000473:pathology; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: Kikuchi disease; Tuberculosis; Tuberculous lymphadenitis; Ultrasonography