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

To review the varied presentations of metastatic cervical lymph node disease in patients with papillary thyroid carcinoma. 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. 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. 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.