Abstract
We used multi-row detector computed tomography (MDCT) to identify the distinguishing characteristics of hepatic paragonimiasis and small hepatocellular carcinoma lesions. We analyzed a cohort of 60 patients, of which 26 had hepatic paragonimiasis and 34 with a small (≤ 3cm) hepatocellular carcinoma. MDCT detected 65 lesions that were retrospectively reviewed and analyzed based on their imaging features. Both groups showed distinct MDCT imaging features that could contribute to an accurate diagnosis. In the paragonimiasis group, 75% (21/28) lesions were located in the hepatic subcapsular region, whereas only 10.8% (4/37) of lesions in the hepatocellular carcinoma group were subcapsular. Most hepatic paragonimiasis lesions (57.1%; 16/28) also showed characteristic tubular or tunnel features that were not present in hepatocellular carcinomas. Further, 71.4% (20/28) paragonimiasis lesions were rim enhanced with irregular tract-like non-enhanced internal areas with a characteristic target loop, while 94.6% (35/37) of small hepatocellular carcinoma lesions showed homogenous enhancement in the arterial and venous phase. In addition, the period CT values for hepatic paragonimiasis were less than those of hepatic carcinomas (P<0.001). These clinically significant findings illustrate the diagnostic features that enable one to distinguish hepatic paragonimiasis from small hepatocellular carcinomas.
Highlights
Paragonimus westermani is a trematode parasite that causes pulmonary or extrapulmonary granulomatous disease in humans infected due to ingestion of raw or incompletely cooked freshwater crab or crayfish infected with metacercaria [1, 2]
For lesions with diameter ≤3 cm, it is difficult to distinguish between hepatic paragonimiasis and hepatocellular carcinoma (HCC)
The diagnosis for paragonimiasis in the liver is based on the pathological analysis of the biopsy that considers (1) coagulative or liquefactive necrosis within the lesion; (2) infiltration of a large number of eosinophils forming chronic eosinophilic abscesses and sporadic distribution of Charcot-Leyden crystals; and (3) hyperplasia of granulomatous and fibrous tissue around the lesion (Figure IIIA, IIIB)
Summary
Paragonimus westermani is a trematode parasite that causes pulmonary or extrapulmonary granulomatous disease in humans infected due to ingestion of raw or incompletely cooked freshwater crab or crayfish infected with metacercaria [1, 2]. Paragonimiasis lesions are situated in the lungs, but ectopic infestation could occur in the brain [3], intra-peritoneal cavity [4, 5], sub-cutaneous tissue [6] and the liver [7, 8]. The involvement of the liver is rare, CT features of hepatic paragonimiasis has been reported in the literature. For lesions with diameter ≤3 cm, it is difficult to distinguish between hepatic paragonimiasis and hepatocellular carcinoma (HCC). The aim of this study was to clarify the Multi-row Detector Computed Tomography (MDCT) features of hepatic paragonimiasis and small hepatocellular carcinoma lesions ≤3cm and identify the distinguishing features
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