The varied presentations of papillary thyroid carcinoma cervical nodal disease: CT and MR findings

PURPOSE: To review the varied presentations of metastatic cervical lymph node disease in patients with papillary thyroid carcinoma. METHODS: Thirteen cases were retrospectively collected and their clinical, imaging, surgical, and pathologic material was reviewed. In the cases reviewed there was no clinical or imaging evidence of a primary thyroid mass. RESULTS: On CT, metastatic nodes can have multiple discrete calcifications, appear as benign cysts or hyperplastic or hypervascular nodes, or have areas of high attenuation which reflect intranodal hemorrhage and/or high concentrations of thyroglobulin. On MR, the nodes can have low to intermediate T1- and high T2- weighted signal intensities or high T1- and T2-weighted signal intensities, the latter reflecting primarily a high thyroglobulin content. CONCLUSION: If any of these varied appearances of cervical lymph nodes are identified on CT or MR, especially in a woman between 20 and 40 years of age, the radiologist should suspect the diagnosis of papillary thyroid carcinoma, even in the absence of a thyroid mass.