Kodama-XUUB: an informative classification for alveolar echinococcosis hepatic lesions on magnetic resonance imaging.

Éléonore Brumpt,Shi Rong,Wenya Liu,Yi Jiang,Tilmann Graeter,Haihua Bao,Éric Delabrousse,Weixia Li,Paul Calame

doi:10.1051/parasite/2021062

Abstract

Objective: To propose a modification of the Kodama classification to classify type III lesions of alveolar echinococcosis (AE) that do not have microcysts. Materials and Methods: 200 magnetic resonance imaging (MRI) images of AE liver lesions from four endemic regions of the world were classified according to Kodama, distinguishing within type III those with microcysts from those without. Each center included 50 MRIs of patients with unoperated AA liver lesions. The first 50 cases were classified by a first reader in the presence of four second-line readers from each region. Then each second-line reader classified his or her 50 cases. Results: In all centers, type III lesions were predominant: 58% of the total lesions and 23% of them were without microcysts. The average age of the patients was 47 years. In China, the patients were on average younger and the lesions larger. German patients had more lesions within the liver. Type I and II lesions, synonymous with earlier diagnosis, were more common in Europe. Conclusion: The Kodama classification needed to be modified because of the existence of a significant proportion of unclassifiable lesions. This is especially true since the presence of microcysts is an informative element of parasite activity. Therefore, this study proposes a Kodama-XUUB classification with type IIIa lesions having microcysts and type IIIb lesions not having microcysts.

Highlights

Alveolar echinococcosis (AE) is a tumor-like parasitic liver disease of the northern hemisphere caused by the larval stage of Echinococcus multilocularis [16, 29]
By comparing data from 200 alveolar echinococcosis (AE) cases from 4 AE reference centers located in endemic areas of Qinghai and Xinjiang in China, and Germany and France in Europe, the XUUB-magnetic resonance imaging (MRI) study presented here is, to the best of our knowledge, the largest series of hepatic MRI cases studied in the literature
This study stresses how different the characteristics of the affected population are in China and Europe, including the number of AE lesions in the liver, and their size and type according to the Kodama classification

Summary

Introduction

Alveolar echinococcosis (AE) is a tumor-like parasitic liver disease of the northern hemisphere caused by the larval stage of Echinococcus multilocularis [16, 29]. The latent phase of AE, before being symptomatic, can exceed 10 years; this is why in 1/3 of cases in Europe, the discovery of the disease is incidental following a medical work-up for fatigue, weight loss or hepatomegaly, through an ultrasound examination or a standard blood test. At this stage, the pseudo-tumor may be responsible for long lasting non-icteric or icteric cholestasis or abdominal pain or be revealed by hepatic biliary or vascular complications, or symptoms related to metastases. Anti-parasitic treatment is indicated over the long term, in many cases for life [27]

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Conclusion