Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Radiol. May 28, 2013; 5(5): 208-214
Published online May 28, 2013. doi: 10.4329/wjr.v5.i5.208
Chronic hepatitis B: Enlarged perihepatic lymph nodes correlated with hepatic histopathology
Jian Shu, Jian-Nong Zhao, Fu-Gang Han, Guang-Cai Tang, Yin-Deng Luo, Li Luo, Xin Chen
Jian Shu, Fu-Gang Han, Guang-Cai Tang, Li Luo, Xin Chen, Department of Radiology, Affiliated Hospital of Luzhou Medical College, Luzhou 646000, Sichuan Province, China
Jian-Nong Zhao, Yin-Deng Luo, Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
Author contributions: Shu J performed the majority of procedures and wrote the manuscript; Zhao JN was involved in conception and design for the manuscript; Han FG and Tang GC edited the manuscript; Luo YD, Luo L and Chen X contributed to data analysis and interpretation.
Correspondence to: Jian Shu, MD, Department of Radiology, Affiliated Hospital of Luzhou Medical College, 319 Zhongshan Road, Luzhou 646000, Sichuan Province, China. shujiannc@163.com
Telephone: +86-830-3165738 Fax: +86-830-3165738
Received: January 7, 2013
Revised: April 23, 2013
Accepted: May 9, 2013
Published online: May 28, 2013
Abstract

AIM: To assess the value of enlarged perihepatic lymph nodes in determining hepatic histopathology for chronic hepatitis B (CHB) by magnetic resonance imaging (MRI).

METHODS: Sixty-seven patients who were clinically and histologically diagnosed with CHB and 18 healthy subjects without history of liver disease underwent abdominal MRI. Histological diagnosis and hepatic inflammation (grade 0-4) and fibrosis (stage 0-4) were assessed by a simplified system for scoring in chronic viral hepatitis. The major imaging protocol included an axial breath-hold fat suppressed fast spoiled gradient echo T2-weighted imaging (T2WI), axial breath-trigger fat suppressed fast recovery fast spin echo T2WI, and axial and coronal fast imaging employing steady-state acquisition. Perihepatic lymph nodes larger than 5 mm in shortest diameter were noted.

RESULTS: The numbers and size indexes of lymph nodes greater than 5 mm in shortest diameter in hepatic hilum suggested inflammatory activity for subjects with grade 2 or higher, with a high accuracy of diagnosis (the area under the curves > 0.9, P < 0.001). The numbers of lymph nodes were 2 or more with a sensitivity of 87.27%, a specificity of 90.00%, an accuracy of 88.24%, a positive predictive value of 94.12%, and a negative predictive value of 79.41% in patients with grade 2 or higher, and the size indexes were no less than 180 mm2 with a sensitivity of 83.64%, a specificity of 100%, an accuracy of 89.41%, a positive predictive value of 100%, and a negative predictive value of 76.92%. The numbers and size indexes of lymph nodes were not correlated with hepatic fibrosis. The signal intensity indexes of lymph nodes were no significant correlation with histological grading or staging of liver.

CONCLUSION: The numbers and size indexes of enlarged perihepatic lymph nodes for patients with CHB suggest inflammatory activity for subjects with grade 2 or higher.

Keywords: Chronic hepatitis B, Magnetic resonance imaging, Lymph nodes, Histopathology, Inflammatory activity

Core tip: Chronic hepatitis B (CHB) is frequently associated with hyperplasia of lymph nodes in the hepatic hilum, and the enlarged lymph nodes can be a good indicator for inflammatory activity of the liver. Enlarged perihepatic lymph nodes for the patients with CHB can be sensitively demonstrated by magnetic resonance imaging, especially fat suppressed T2-weighted imaging. The numbers and size indexes of lymph nodes larger than 5 mm in shortest diameter suggest inflammatory activity for subjects with grade 2 or higher, with a high accuracy of diagnosis at a cutoff value of 2 for the numbers or 180 mm2 for the size indexes of lymph nodes.