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. 2020 Feb 18;10(8):3612–3621. doi: 10.7150/thno.40606

Figure 3.

Figure 3

Differentiation of benign and malignant lymph nodes in pediatric patients: Example of a benign lymph node in the left axillary of a 16 year old boy with Ewing's sarcoma (left row) and a malignant lymph node in the left para-aortic retroperitoneal region of a 14 year old boy with a desmoplastic small round cell tumor (middle row). (A, B) Ferumoxytol-enhanced T2-weighted FSE images show a hypointense hilum of the benign lymph node (A) and lack of hypointense enhancement of the malignant node (B). (C) The mean size of 464 benign and 149 malignant lymph nodes on T2-FSE images was significantly different (p<0.0001). (D, E) Apparent diffusion coefficient (ADC) maps demonstrate unrestricted diffusion (bright signal) of the benign lymph node (D) and restricted diffusion (dark signal) of the malignant lymph node (E). (F) The mean ADC value of 464 benign and 149 malignant lymph nodes on diffusion-weighted images was significantly different (p<0.0001). (G, H) 18F-FDG PET images demonstrate background signal of the benign lymph node (G) and markedly increased FDG uptake of the malignant lymph node (H) compared to normal background tissue. (I) The mean standardized uptake value (SUV) ratio of 464 benign and 149 malignant lymph nodes was significantly different (p<0.0001). (J, K) R2* relaxation rate maps demonstrate increased R2* (=shortened T2*) of the benign lymph node due to increased iron content and short R2* (= long T2*) of the malignant lymph node. The mean R2* relaxation rate of 464 benign and 149 malignant lymph nodes was significantly different (p<0.0001). 18F-FDG: 2-deoxy-2-[F-18]fluoro-D-glucose; ADCmean: mean apparent diffusion coefficient; FSE: fast spin echo; PET: positron emission tomography; R2*: R2*-relaxation rate; SUV: standardized uptake value; SUV-ratio: SUVmax lymph node/SUVmean liver.