Zeynep ATCEKEN, Erdem CIG, Yuksel PEKER, Taner TAN
The European Research Journal - 2026;12(8):824-833
Objective: To investigate clinical determinants of mediastinal lymph node attenuation (MLNA) on non-contrast chest computed tomography (CT), focusing on smoking history and cardiometabolic factors. Methods: In this retrospective single-center study, individuals undergoing non-contrast chest CT without known cardiopulmonary disease were included. MLNA was measured in Hounsfield units (HU) from the largest visible mediastinal lymph node. Smoking status (ever vs never), age, sex, hypertension, diabetes mellitus, and body mass index were recorded. Multivariable linear regression identified independent predictors of MLNA. Receiver operating characteristic (ROC) analysis evaluated attenuation for discriminating smoking history. Results: A total of 138 individuals were analyzed (82 ever smokers, 56 never smokers). MLNA was higher in ever smokers than never smokers (median 39.5 vs 35 HU, P=0.001). In multivariable analysis, smoking history remained independently associated with increased attenuation (B=5.48 HU, 95% confidence interval [CI]: 1.72-9.23, P=0.005). Age (B=0.33 HU/year, P<0.001), hypertension (B=6.55 HU, P=0.009), and diabetes mellitus (B=5.93 HU, P=0.043) were also independent predictors, whereas sex and BMI were not significant. The model explained 41% of attenuation variance (R²=0.41). ROC analysis demonstrated moderate discrimination for smoking history (area under curve [AUC] = 0.66; optimal cut-off 46 HU, specificity of 89.3%). Attenuation values were highest among current smokers in exploratory analyses. Conclusion: Smoking history, age, hypertension, and diabetes mellitus are independently associated with increased mediastinal lymph node attenuation on non-contrast CT. Elevated attenuation may reflect chronic inflammatory activation, fibrotic remodeling, and cumulative cardiometabolic tissue injury rather than overt pathology, supporting its role as a contextual imaging marker in risk-aware radiologic interpretation.
