Advancement of imaging diagnosis technique and surgery treatment of echinococcosis

Abstract

Hydatid disease is a zoonosis seriously affecting the population in western China.Surgery is the primary treatment.Through the investgation on the imaging diagnosis and various surgical methods of cystic echinococcosis (CE) and alveolar echinococcosis (AE),this review described:1.Ultrasonic inspection is mainly used for diagnosis and differential diagnosis of CE and AE,especially during epidemic investigation and mass screening.It is the first choice for convenient carrying and low energy consuming.Lately,based on 2-dimensional ultrasound and Doppler color flow imaging (DCFI),gray scale ultrasound opacification is performed for CE and AE.Ultrasound opacification can show focal compass and condition of microcirculation better,providing more therapy information for surgery of hepatic echinococcosis.2.Granular echinococcusis appears as a cyst with clear boundary.The characteristic sighs of the lesion include daughter cyst,detached cystic membrane,wall or content calcification.AE is demonstrated as a map-like heterogenons mass with scattered calcification and center necrosis.The aggrevasion of the lesion may compress or destroy the hepatic vessels or bile ducts.MRI showes advantage in diagnosis of those untypical echinococcnsis.CT/MRI angiography and cholangiography are used for detection of the complications.CT/MRI perfusion,diffusion wightted imaging and MRl spectrum may provide the molecular imaging to visualize the echinococcusis in vitro.3.CE:3.1 Total cystectomy can be considered as radical and practicable surgical method for human CE,it is the first choice for both radical and conservative surgical operation.3.2 Subtotal cystectomy may not only eliminate residual cavity,but also effectively decrease the risk of the total cystectomy.3.3 In case that is not eligible for radical surgery,conservative surgery can be an effective alternative way to excise remaining cavity while in which retrograde methylene blue infusion technique can efficiently explore biliary communications.4.AE:4.1 The rational treatment for liver AE is radical hepatectomy and the prognosis of the patient may be good.4.2 For liver unresectable case,palliative operation may be indicated.It should be used prudently for it may result in serious biliary fistula on liver surface.4.3 Liver transplantation was the last choice for the terminal stage of CE and AE,however it still has possibility of post-operation recurrence.Effective drug treatment,such as liposmal albendazole,can be used for prolonging patients' life. Key words: Cystic echinococcosis; Alveolar echinococcosis; Total cystectomy; Endocystectomy; Hepatectomy; Ultrasonic inspection; CT inspection; CT angiography; MRI inspection