Treatment assessment based on computerized lymph node volume and ratio of necrotic area in tuberculous cervical lymphadenitis.

OBJECTIVE: The objective of this study was to investigate the feasibility of computerized segmentation of lymph nodes to evaluate the relationship of treatment outcomes in tuberculous cervical lymphadenitis (TCL). METHODS: The study included 52 subjects with TCL that had CT before standard medical treatment. The relationship between the medication treatment response, volume and ratio of necrotic area of the largest lymph node in patients with TCL was evaluated. The treatment outcome was defined as the 'responder' (n=35) and 'non-responder' (n=17) groups. Seventeen non-responder patients required surgery. RESULTS: The average lymph node volumes and ratio of necrotic area were 58.59cm(3) (range, 4.96-249.48cm(3)) and 0.30 (range, 0-0.59), respectively. There was a significant difference in the lymph node volumes (34.91±24.00cm(3) vs. 107.04±69.12cm(3), p<0.001) and ratio of necrotic area (0.26±0.12 vs. 0.40±0.14, p=0.001) between responders and non-responders. The receiver-operating-characteristic (ROC) curve analysis was used for differentiating responders from non-responders; it showed that the area under the curve for the lymph node volumes and ratio of necrotic area was 0.845 and 0.759, respectively. The cut-off value for the lymph node volumes and ratio of necrotic area was 44.15cm(3) and 0.36 based on the ROC curve. CONCLUSIONS: A large lymph node volume and high ratio of necrotic area on the 3D reconstruction of CT images were associated with the response to medical treatment for TB. These findings might be useful for assessing treatment outcomes.