Skip to main content

Advertisement

SpringerLink
Log in

What is the pelvic lymph node normal size? Determination from normal MRI examinations

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

There are few previous reports on maximal pelvic lymph node sizes and no data on normal mesorectal nodes. Therefore, the aim of the study was to estimate the normal size of pelvic lymph nodes and to determine the upper limits of the normal range.

Materials and methods

Pelvic magnetic resonance imaging (MRI) examinations were prospectively carried out using a Intera 1.5 T magnet (Philips, the Netherlands), on 36 healthy volunteers (22 females, 14 males, mean age 25 years). A balanced fast field echo (b-FFE) sequence was used with the following parameters: 3-mm-thick contiguous slice, matrix 512 × 512. Short axis diameters of pelvic and inguinal lymph nodes were measured in each anatomic territory (internal iliac, external iliac, common iliac, mesorectum and inguinal). After normalization of the measurements, the influences of age, gender, laterality and territory were evaluated. Upper limits (95th percentile) were then calculated.

Results

A total of 1147 lymph nodes were measured. Age, gender and side (right/left) had no significant influence on size. The upper limits of the normal range were, respectively, 5.3, 4.4, 6.3 and 3.9 mm for the external and common iliac, internal iliac, inguinal and mesorectum nodes.

Conclusion

This work presents maximal normal values for each pelvic area, and the values for mesorectum nodes are reported for the first time.

Advances in knowledge

The mesorectum nodes should be considered as abnormal when they are over 4 mm in short diameter. For the other node areas, the upper limits of the normal range were, respectively, 6, 6, 5, 7 mm for the external and common iliac, internal, iliac and inguinal nodes for the short axis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Brown HG, Luckasevic TM, Medich DS, Celebrezze JP, Jones SM (2004) Efficacy of manual dissection of lymph nodes in colon cancer resections. Mod Pathol 17:402–406. doi:10.1038/modpathol.3800071

    Article  PubMed  Google Scholar 

  2. Brunocilla E, Ceci F, Schiavina R, Castellucci P, Maffione AM, Cevenini M, Bianchi L, Borghesi M, Giunchi F, Fiorentino M, Chondrogiannis S, Colletti PM, Rubello D, Fanti S, Martorana G (2014) Diagnostic accuracy of (11) C-choline PET/CT in preoperative lymph node staging of bladder cancer: a systematic comparison with contrast-enhanced CT and histologic findings. Clin Nucl Med 39:e308–e312. doi:10.1097/RLU.0000000000000342

    Article  PubMed  Google Scholar 

  3. Choi EK, Kim JK, Choi HJ, Park SH, Park BW, Kim N, Kim JS, Im KC, Cho G, Cho KS (2009) Node-by-node correlation between MR and PET/CT in patients with uterine cervical cancer: diffusion-weighted imaging versus size-based criteria on T2WI. Eur Radiol 19:2024–2032. doi:10.1007/s00330-009-1350-5

    Article  PubMed  Google Scholar 

  4. Cousins A, Thompson SK, Wedding AB, Thierry B (2014) Clinical relevance of novel imaging technologies for sentinel lymph node identification and staging. Biotechnol Adv 32:269–279. doi:10.1016/j.biotechadv.2013.10.011

    Article  PubMed  Google Scholar 

  5. Damin DC, Tolfo GC, Rosito MA, Spiro BL, Kliemann LM (2010) Sentinel lymph node in patients with rectal cancer invading the anal canal. Tech Coloprotol 14:133–139. doi:10.1007/s10151-010-0582-3

    Article  CAS  Google Scholar 

  6. Dooms GC, Hricak H, Crooks LE, Higgins CB (1984) Magnetic resonance imaging of the lymph nodes: comparison with CT. Radiology 153:719–728. doi:10.1148/radiology.153.3.6093190

    Article  CAS  PubMed  Google Scholar 

  7. Drieskens O, Stroobants S, Gysen M, Vandenbosch G, Mortelmans L, Vergote I (2003) Positron emission tomography with FDG in the detection of peritoneal and retroperitoneal metastases of ovarian cancer. Gynecol Obstet Invest 55:130–134. doi:10.1159/000071525

    Article  CAS  PubMed  Google Scholar 

  8. Forsberg L, Dale L, Hoiem L, Magnusson A, Mikulowski P, Olsson AM, Ous S, Stenwig AE (1986) Computed tomography in early stages of testicular carcinoma. Size of normal retroperitoneal lymph nodes and lymph nodes in patients with metastases in stage II A. A SWENOTECA study: Swedish–Norwegian Testicular Cancer Project. Acta Radiol 27:569–574

    Article  CAS  Google Scholar 

  9. Grey AC, Carrington BM, Hulse PA, Swindell R, Yates W (2000) Magnetic resonance appearance of normal inguinal nodes. Clin Radiol 55:124–130. doi:10.1053/crad.1999.0330

    Article  CAS  PubMed  Google Scholar 

  10. Grubnic S, Vinnicombe SJ, Norman AR, Husband JE (2002) MR evaluation of normal retroperitoneal and pelvic lymph nodes. Clin Radiol 57:193–200. doi:10.1053/crad.2001.0893 (discussion 201–194)

    Article  PubMed  Google Scholar 

  11. Klerkx WM, Heintz AP, Mali WP, de Kort GA, Takahara T, van Dorst EB, Peeters PH (2009) Lymph node detection by MRI before and after a systematic pelvic lymphadenectomy. Gynecol Oncol 114:315–318. doi:10.1016/j.ygyno.2009.05.007

    Article  CAS  PubMed  Google Scholar 

  12. Koh DM, Brown G, Temple L, Raja A, Toomey P, Bett N, Norman AR, Husband JE (2004) Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings—initial observations. Radiology 231:91–99. doi:10.1148/radiol.2311030142

    Article  PubMed  Google Scholar 

  13. Krag D, Weaver D, Ashikaga T, Moffat F, Klimberg VS, Shriver C, Feldman S, Kusminsky R, Gadd M, Kuhn J, Harlow S, Beitsch P (1998) The sentinel node in breast cancer—a multicenter validation study. N Engl J Med 339:941–946. doi:10.1056/NEJM199810013391401

    Article  CAS  PubMed  Google Scholar 

  14. Kwee TC, Takahara T, Luijten PR, Nievelstein RA (2010) ADC measurements of lymph nodes: inter- and intra-observer reproducibility study and an overview of the literature. Eur J Radiol 75:215–220. doi:10.1016/j.ejrad.2009.03.026

    Article  PubMed  Google Scholar 

  15. Lahaye MJ, Engelen SM, Kessels AG, de Bruine AP, von Meyenfeldt MF, van Engelshoven JM, van de Velde CJ, Beets GL, Beets-Tan RG (2008) USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology 246:804–811. doi:10.1148/radiol.2463070221

    Article  PubMed  Google Scholar 

  16. Lengele B, Scalliet P (2009) Anatomical bases for the radiological delineation of lymph node areas. Part III: pelvis and lower limbs. Radiother Oncol 92:22–33. doi:10.1016/j.radonc.2008.11.007

    Article  PubMed  Google Scholar 

  17. Mangan CE, Rubin SC, Rabin DS, Mikuta JJ (1986) Lymph node nomenclature in gynecologic oncology. Gynecol Oncol 23:222–226

    Article  CAS  PubMed  Google Scholar 

  18. Matsuoka H, Masaki T, Kobayashi T, Sato K, Sugiyama M, Atomi Y, Ohkura Y (2009) Morphological criteria for metastatic mesorectal lymph nodes in rectal cancer. Hepato-Gastroenterol 56:1661–1664

    Google Scholar 

  19. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, Nieweg OE, Roses DF, Hoekstra HJ, Karakousis CP, Reintgen DS, Coventry BJ, Glass EC, Wang HJ, Group M (2006) Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 355:1307–1317

    Article  CAS  PubMed  Google Scholar 

  20. Nakai G, Matsuki M, Inada Y, Tatsugami F, Tanikake M, Narabayashi I, Yamada T (2008) Detection and evaluation of pelvic lymph nodes in patients with gynecologic malignancies using body diffusion-weighted magnetic resonance imaging. J Comput Assist Tomogr 32:764–768. doi:10.1097/RCT.0b013e318153fd43

    Article  PubMed  Google Scholar 

  21. Ogawa S, Kobayashi H, Amada S, Yahata H, Sonoda K, Abe K, Baba S, Sasaki M, Kaku T, Wake N (2010) Sentinel node detection with (99m)Tc phytate alone is satisfactory for cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy. Int J Clin Oncol 15:52–58. doi:10.1007/s10147-009-0010-8

    Article  CAS  PubMed  Google Scholar 

  22. Perez RO, Pereira DD, Proscurshim I, Gama-Rodrigues J, Rawet V, Sao Juliao GP, Kiss D, Cecconello I, Habr-Gama A (2009) Lymph node size in rectal cancer following neoadjuvant chemoradiation–can we rely on radiologic nodal staging after chemoradiation? Dis Colon Rectum 52:1278–1284. doi:10.1007/DCR.0b013e3181a0af4b

    Article  PubMed  Google Scholar 

  23. Querleu D, Ferron G, Rafii A, Bouissou E, Delannes M, Mery E, Gladieff L (2008) Pelvic lymph node dissection via a lateral extraperitoneal approach: description of a technique. Gynecol Oncol 109:81–85. doi:10.1016/j.ygyno.2007.12.031

    Article  PubMed  Google Scholar 

  24. Schwartz LH, Bogaerts J, Ford R, Shankar L, Therasse P, Gwyther S, Eisenhauer EA (2009) Evaluation of lymph nodes with RECIST 1.1. Eur J Cancer 45:261–267. doi:10.1016/j.ejca.2008.10.028

    Article  CAS  PubMed  Google Scholar 

  25. Vinnicombe SJ, Norman AR, Nicolson V, Husband JE (1995) Normal pelvic lymph nodes: evaluation with CT after bipedal lymphangiography. Radiology 194:349–355. doi:10.1148/radiology.194.2.7824709

    Article  CAS  PubMed  Google Scholar 

  26. Weissleder R, Elizondo G, Wittenberg J, Lee AS, Josephson L, Brady TJ (1990) Ultrasmall superparamagnetic iron oxide: an intravenous contrast agent for assessing lymph nodes with MR imaging. Radiology 175:494–498. doi:10.1148/radiology.175.2.2326475

    Article  CAS  PubMed  Google Scholar 

  27. Xiong L, Engel H, Gazyakan E, Rahimi M, Hunerbein M, Sun J, Kneser U, Hirche C (2014) Current techniques for lymphatic imaging: state of the art and future perspectives. Eur J Surg Oncol 40:270–276. doi:10.1016/j.ejso.2013.11.027

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Imaging, University Hospital of Poitiers, Poitiers, France

    Marjorie Ramirez, Guillaume Herpe, Guillaume Vesselle, Samy Boucebci & Jean-Pierre Tasu

  2. Epidemiology and Biostatistics Laboratory, INSERM CIC-0802, University of Poitiers, Poitiers, France

    Pierre Ingrand

  3. Anatomy and Simulation Laboratory, University of Poitiers, Poitiers, France

    Jean-Pierre Richer

  4. Department of Abdominal Surgery, University Hospital of Poitiers, Poitiers, France

    Jean-Pierre Richer

  5. DACTIM, Research Unit on Functional Imaging, University of Poitiers, Poitiers, France

    Jean-Pierre Tasu

  6. CHU Poitiers, Service d’imagerie médicale, 2 rue de la Milétrie, 86000, Poitiers, France

    Jean-Pierre Tasu

Authors
  1. Marjorie Ramirez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pierre Ingrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Pierre Richer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guillaume Herpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guillaume Vesselle
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samy Boucebci
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean-Pierre Tasu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Pierre Tasu.

Ethics declarations

Conflict of interest

No conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramirez, M., Ingrand, P., Richer, JP. et al. What is the pelvic lymph node normal size? Determination from normal MRI examinations. Surg Radiol Anat 38, 425–431 (2016). https://doi.org/10.1007/s00276-015-1581-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-015-1581-x

Keywords

Search

Navigation