Abstract
Background. Alveolar echinococcosis (AE) is a rare zoonosis caused by the larval stage of the tapeworm Echinococcus multilocularis. AE lesions affect the liver in more than 98% of cases. AE lesions have various morphological characteristics that are described in the Echinococcus multilocularis Ulm classification for computed tomography (EMUC-CT). One of these characteristics is a cystoid portion. The aim of the study was to compare the density of simple hepatic cysts with cystoid portions of AE lesions classified on the basis of the EMUC-CT. Results. Hounsfield Unit (HU) measurements of the cystoid portions of all EMUC-CT type I–IV AE lesions (n = 155) gave a mean of 21.8 ± 17.6, which was significantly different from that of 2.9 ± 4.5 for the simple hepatic cysts (p < 0.0001). The difference between each of the individual AE types and simple hepatic cysts was also significant. In addition, the HU values of the cystoid portions in types I, II and IIIa/b and simple cysts were each significantly different from type IV (p < 0.0001). The HU measurements in type IV presented by far the highest mean. Conclusions. The significantly higher density measured in the cystoid portions of hepatic AE lesions offers a good means of differentiation from simple hepatic cysts.
Highlights
Alveolar echinococcosis (AE) is a rare zoonosis caused by the larval stage of the fox tapeworm (Echinococcus multilocularis)
The aim of the study was to compare the density of simple hepatic cysts with cystoid portions of AE lesions classified on the basis of the Echinococcus multilocularis Ulm classification for computed tomography (EMUC-computed tomography (CT))
Distribution of the lesions in the lobes of the liver in the study and control groups In the study group, the largest AE lesions were found in the right lobe of the liver in 86 cases (55.4%) and in the left lobe in 36 patients (23.2%)
Summary
Alveolar echinococcosis (AE) is a rare zoonosis caused by the larval stage of the fox tapeworm (Echinococcus multilocularis). Humans may become infected by ingesting contaminated food or direct contact with animals [1, 37] In such cases, humans act as aberrant intermediate hosts, as they do not belong to the natural life cycle of the parasite [10] and the formation of protoscolices is possible only in exceptional cases [8]. One therapeutic option in terms of curative treatment is complete resection of the lesion, but this depends on the stage of the disease. If surgery is no longer an option, long-term pharmacotherapy with benzimidazole (BMZ) derivatives is indicated Such treatment may inhibit further growth of the lesion and achieve a stable phase of the disease [4, 5, 10, 31]. Histopathological findings and molecular DNA identification are used to confirm the diagnosis [39]
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