Hepatic Alveolar Echinococcosis Research Articles

Good outcome following liver transplantation using pericardial-peritoneum window for hepato-atrial anastomosis to overcome advanced hepatic alveolar echinococcosis and secondary Budd-Chiari Syndrome - a case report

BackgroundThis report presents a case of a 57- year old female with advanced Hepatic Alveolar Echinococcosis causing a secondary Budd-Chiari Syndrome due to infiltration of the suprahepatic inferior vena cava treated successfully by liver transplantation.Case presentationA temporary veno-venous bypass was introduced, but a typical end to end cavo-caval anastomosis wasn’t possible in this case. In order to access a disease free part of the inferior vena cava, an oval window of the diaphragm was excised, providing communication between the peritoneum and pericardium. A vascular clamp was placed onto the right atrium which allowed for an atrial-caval anastomosis. The remainder of hepatectomy was performed in a conventional manner. In the post-operative period and during the 18 month follow-up there were no complications. The patient remains in good general condition with optimal graft function.ConclusionsA hepato-atrial anastomosis with a pericardial-peritoneum window during liver transplantation is feasible and extends the curability potential for patients with advanced Hepatic Alveolar Echinococcosis considered for liver transplantation.

Management of Advanced Hepatic Alveolar Echinococcosis: Report of 42 Cases.

Radical resection is the first choice for hepatic alveolar echinococcosis (HAE). However, many patients with advanced HAE have no chance to be treated with curative resection owing to the long clinical latency. This study aimed to evaluate the necessity of aggressive operations, like palliative resection and orthotopic liver transplantation (OLT), in the management of advanced HAE. A retrospective study analyzed 42 patients with advanced HAE treated with palliative resection (N = 15), palliative nonresective procedures (N = 13), OLT (N = 3), or albendazole therapy alone (N = 11). The patients' condition before treatments was comparable among all the four groups. The overall 1-year, 3-year, and 5-year survival rates of the 42 cases were 81.0%, 45.2%, and 23.8%, respectively. No event occurred to end the follow-up during the 5-year observation period except death. The survival time (median ± standard error) of the palliative resection group (3.6 ± 1.4 years) was longer than that of the palliative nonresective procedures group (1.5 ± 0.2) and the albendazole therapy-alone group (1.0 ± 0.4). The 5-year survival rates after palliative resection and liver transplantation were 40.0% and 66.7%, compared with only 7.7% and 9.1% after palliative nonresective procedures or albendazole therapy alone. Therefore, we concluded that aggressive treatment with a multimodality strategy could contribute to prolonged survival in patients with advanced HAE. Moreover, the prognosis of the patients who received albendazole therapy alone or palliative nonresective procedures is poor.

Effect of ulinastatin on hepatic ischemia-reperfusion injury in patients with hepatic alveolar echinococcosis in plateau region

Objective To evaluate the effect of ulinastatin on hepatic ischemia-reperfusion injury in patients with hepatic alveolar echinococcosis in plateau region. Methods Sixty patients with hepatic alveolar echinococcosis in plateau region, weighing 45-75 kg, aged 30-55 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective partial hepatectomy, were divided into control group(C group)and ulinastatin group(U group)using a random number table, with 30 patients in each group.Ulinastatin 12 000 U/kg(in 100 ml of normal saline)was infused intravenously at 20 min before occlusion of hepatic portal in group U, and normal saline 100 ml was given instead in group C. Before operation, at 10 min after occlusion of hepatic portal, at 20 min and 1 h after unclamping hepatic portal and at 12 h after operation, blood samples were collected from the right internal jugular vein for determination of the levels of serum alanine aminotransferase, aspartate aminotransferase and malondialdehyde. Results Compared with group C, the levels of serum alanine aminotransferase, aspartate aminotransferase and malondialdehyde were significantly decreased at 20 min and 1 h after unclamping hepatic portal and 12 h after operation in group U(P<0.05). Conclusion Ulinastatin can attenuate hepatic ischemia-reperfusion injury in patients with hepatic alveolar echinococcosis in plateau region. Key words: Trypsin inhibitors; Altitude; Echinococcosis; Liver; Reperfusion injury

Modern role of clinical ultrasound in liver abscess and echinococcosis.

In the Western world, liver abscesses are predominantly of pyogenic origin and can present a wide range of ultrasonographic features, from a solid mass to a cystic cavity. Amoebic abscesses are endemic in tropical areas and typically round single lesions. Echinococcal cyst is diagnosed by ultrasound (US). Serology is particularly useful when pathognomonic US features are absent. Treatment is determined based on the WHO ultrasonographic classification, and puncture, aspiration, injection, re-aspiration (PAIR) is a US-guided therapeutic option. Hepatic alveolar echinococcosis presents on US as a pseudotumoral mass frequently with calcifications that may invade the biliary tree and portal and hepatic veins.

Visualization and Pathological Characteristics of Hepatic Alveolar Echinococcosis with Synchrotron-based X-ray Phase Sensitive Micro-tomography.

Propagation-based phase-contrast computed tomography (PPCT) utilizes highly sensitive phase-contrast technology applied to X-ray micro-tomography, especially with the extensive use of synchrotron radiation (SR). Performing phase retrieval (PR) on the acquired angular projections can enhance image contrast and enable quantitative imaging. We employed the combination of SR-PPCT and PR for the histopathological evaluation of hepatic alveolar echinococcosis (HAE) disease and demonstrated the validity and superiority of PR-based SR-PPCT. A high-resolution angular projection data set of a human postoperative specimen of HAE disease was acquired, which was processed by graded ethanol concentration fixation (GECF). The reconstructed images from both approaches, with the projection data directly used and preprocessed by PR for tomographic reconstruction, were compared in terms of the tissue contrast-to-noise ratio and density spatial resolution. The PR-based SR-PPCT was selected for microscale measurement and the 3D visualization of HAE disease. Our experimental results demonstrated that the PR-based SR-PPCT technique is greatly suitable for the discrimination of pathological tissues and the characterization of HAE. In addition, this new technique is superior to conventional hospital CT and microscopy for the three-dimensional, non-destructive microscale measurement of HAE. This PR-based SR-PPCT technique has great potential for in situmicroscale histopathological analysis and diagnosis, especially for applications involving soft tissues and organs.

REMOVED: Liver autotransplantation and retrohepatic vena cava reconstruction for alveolar echinococcosis

Alveolar echinococcosis (AE) is characterized by a slow-growing infiltrative neoplasm that is often unresectable by traditional methods because of strong adhesions and invasion to adjacent structures. We present our experience with liver autotransplantation and retrohepatic inferior vena cava (RHIVC) reconstruction using autogenous veins in patients with this end-stage parasitic disease. Twelve patients with hepatic AE and extensive RHIVC, hepatic vein, and/or hilar invasion underwent exvivo liver resection and RHIVC reconstruction using autogenous veins followed by autotransplantation in the West China Hospital of Sichuan University from 2013 to2016. The mean weight of the harvested liver graft was 537g (range: 390-900g), the mean anhepatic time was 216min (range, 120-310min), and the mean operation time was 13.6h (range, 10.5-19.5h). The main postoperative complication was bile leakage. The mean postoperative hospital stay was 16.4d (range, 10.0-37.0d), and the median follow-up time was 15.5mo (range, 1.0-32.0 mo). All patients were alive at the latest follow-up. The vascular patency rate was 100%, and no residual disease, recurrence, or metastasis was detected. To our knowledge, liver autotransplantation and RHIVC reconstruction using autogenous veins are rarely performed for patients with end-stage hepatic AE. This technique requires no organ donor, allogeneic, or artificial vessel implantation, postoperative immunosuppressive therapy, or long-term postoperative anticoagulant treatment. These benefits may make the treatment of select end-stage hepatic AE patients more affordable and effective.

Hepatectomy for patients with alveolar echinococcosis: Long-term follow-up observations of 144 cases

BackgroundWestern China is a region in which alveolar echinococcosis (AE) is endemic. Few studies and comparisons have evaluated the outcomes of AE patients after hepatectomy, and no strategy has been defined for the treatment of AE patients with unresectable tumors. This study sought to assess the outcomes of AE patients after hepatectomy at a tertiary referral center. Patients and methodsWe retrospectively analyzed data from 144 patients with hepatic AE who were treated via hepatectomy at our center between January 2004 and December 2015. Patients' overall survival (OS), progression-free survival (PFS), and risk factors were analyzed, and Kaplan–Meier survival curves were constructed. Patient age, year of initial treatment, PNM stage, and risk factors were entered as co-variates in a Cox regression modle that was used for analysis. ResultsHepatectomy was performed in 144 patients diagnosed with hepatic AE (84 complete resections and 60 reduction surgeries). In the complete resection group, the 5- and 10-year OS rates were both 97.6%, and the 5- and 10-year PFS rates were both 97.9%. In the reduction surgery group, the 5-, and 10-year OS rates were 89.7% and 73.4%, respectively, and the 5-, and 10-year PFS rates were 78.1% and 69.5%, respectively. Patients in the complete group had better OS prognoses and PFS than patients in the reduction surgery group (P = 0.018 and P = 0.001). Multivariate analysis indicated that curability and portal vein invasion are independent factors associated with PFS (P = 0.028 and P = 0.006). ConclusionsThe most effective therapy for AE is complete resection. Reduction surgery does not appear to offer obvious advantages over benzimidazole therapy alone in the treatment of AE. Curability and portal vein invasion are independent prognostic factors for PFS in a multivariate analysis.

Application of three-dimensional visualization technology in surgical treatment for patients with hepatic alveolar echinococcosis

To determine the clinical value of three-dimensional(3D) visualization technology in pre-operative assessment and surgical planning for patients with hepatic alveolar echinococcosis. Eighty-five hepatic alveolar echinococcosis patients received surgical treatment in the First Affiliated Hospital of Xinjiang Medical University between May 2011 and May 2015.3D reconstruction and virtual surgeries were performed on diseased livers using a 3D visualization reconstruction system for liver, which based on the data set of 64-slice CT from those patients and indicated the feasibility and safety of liver resection. The pre-operative measurement results were compared with intra-operative conditions to verify the accuracy of pre-operative evaluation. All surgical strategies of patients underwent surgical treatment(59 of 85 received traditional liver resection and 26 of 85 received liver auto-transplantation)were consistent with pre-operative surgical planning in 3D reconstruction. Furthermore, the pre-operative resection liver volume((751±510)cm(3)) estimated by 3D calculation method was positively correlated with the actual weight((777±567)g) after the surgery(r=0.990), and the error rate was 4.7%; the pre-operative remaining liver volume((829±157)cm(3)) estimated by 3D calculation method was positively correlated with the actual weight((770±206) g) after the surgery(r=0.978). Patients were followed for 6-46 months after the surgery, and 3 post-operative death and 2 recurrence (one case received secondary surgery and one case received drug therapy) were reported during the follow-up period. A liver 3D visualization technology has application value in the pre-assessment and surgical planning.When it combined with ultrasound, CT and MRI, traditional examinations, the liver 3D visualization technology can effectively improve the success rate of operation, reduce the risks of surgery.

Clinical application of dual energy spectral CT method in patients with hepatic alveolar echinococcosis

PurposeTo investigate the usefulness of dual energy spectral computed tomographic (DESCT) imaging parameters in diagnosing hepatic alveolar echinococcosis (AE) disease by comparing with traditional CT. Materials and methodsIn this prospective study, 35 consecutive patients (22 men, 13 women; mean age, 42.6 years) suffering from hepatic echinococcosis (HE) (HE cases were confirmed by surgery, pathology or multiple imaging methods) underwent abdominal DESCT scan, consisting of arterial phase (AP), portal venous phase (PVP) and delayed phase (DP), in dual-energy (80 kV/140 kV) mode. 15 patients had AE; 20 patients were pathologically confirmed cystic echinococcosis (CE). The CT patterns of the AE lesions were classified into solid, pseudocystic, or mixed type. The size, location, invasion findings were recorded. The serial function images (ie, iodine-based material-decomposition CT images, contrast-to-noise ratio images, monochromatic images, spectral curve images) from DESCT data were processed with a software algorithm designed to calculate optimal CNR value, quantitative iodine concentration (QIC), curve slope for evaluation of HE lesions. Sensitivity and specificity were compared between the qualitative and quantitative studies for DESCT and traditional CT in HE. The two-sample test and ROC curve analyses were performed to compare quantitative parameters between AE and CE. ResultsA total of 18 AE lesions (6 solid, 2 pseudocystic, and 10 mixed) with average 87.6 ± 50.7 mm lesion size were assessed. DECT detected more contrast enhanced lesions (71.6%) than traditional CT (50.9). There was a significant difference in the QICs between various layers of the HAE in each of the three scan phases (P < 0.001). The QICs in the marginal zone were significantly higher than that in solid or cystic layers and liver parenchyma. No significant difference was found among the various CT patterns of hepatic AE. 65 keV is the optimal monochromatic image with corresponding contrast noise radio (CNR) 10.24 ± 2.62. The spectrum curve showed “inversed saddle pattern” for HAE lesion. The differences of slopes between solid, margin zone and normal liver parenchyma of HAE lesion were of statistical significances in the region of 40–60 keV and 60–70 keV (P < 0.05). There were statistical significances in slopes of spectrum curve between AE and CE with different keV regions. The spectrum curve of CT was in gradual falling type. ROC showed the areas under the curves (AUC) for k values to differentiate between AE and CE were 1 in region of 40–60 keV and 0.847 in region of 70–140 keV. ConclusionsDESCT could provide more information by using monochromatic images, iodine-based material decomposition images and the quantitative analysis of IC than traditional CT for the diagnosis of HE.

Evaluation of experimentally induced early hepatic alveolar echinococcosis in rats with ultrasonography

ObjectivesThe aim of this study was to explore the value of ultrasonography in screening the early stage of hepatic alveolar echinococcosis (HAE) in animal model, and to demonstrate characteristic imaging of early HAE in ultrasonography. Materials and methodsThe early stage of experimentally induced secondary HAE in 157 rats was studied by ultrasonography. The features of all lesions were recorded, and compared with pathological results. ResultsThe sensitivity and specificity of ultrasonography was 93.5%, (95% confidence interval: 76%–98%) and 83.3% (95% confidence interval: 65%–93%), respectively. The typical features of early HAE in ultrasonography presented as solid hyperechoic masses and mixed lesions. Blood flow was detected in only three lesions by Color Doppler Flow Imaging. Calcifications were detected in 17 lesions which were larger than 8 mm. Lesions presented as single or multiple cystic structure, surrounded with the proliferation of small blood vessels, epithelioid cells, macrophages, fibroblasts, lymphocytes and fibrous tissue in the liver. ConclusionsOur data suggested that ultrasonography could be used as a screening method for early Echinococcusmultilocularis lesions in the animal model. Calcification could be occurred in those lesions with fast growth of the parasite in short cycle. The typical features of early HAE presented as hyper-echoic with small size in ultrasonography.

The role of diffusion-weighted imaging in differentiation of hepatic alveolar echinococcosis and intrahepatic cholangiocarcinoma

ObjectiveA technique is proposed for evaluating the utility of apparent diffusion coefficient (ADC) measurements in the differentiation of type 4 hepatic alveolar echinococcosis (HAE) from the mass-forming type of intrahepatic cholangiocarcinoma (IHCC), using diffusion-weighted magnetic resonance imaging (DW-MRI). MethodsThis study, conducted from November 2013 to January 2015, was approved by the ethics committee of First Affiliated Hospital of Xinjiang Medical University. All patients were given written informed consent. A total of 11 patients underwent T1WI, T2 fat-saturation, and a respiratory triggered DWI sequence by a 1.5T MR imaging system. An experienced radiologist measured the ADC in both alveolar echinococcosis and cholangiocarcinoma lesions. DWI was performed with a b-value gradient of 0 and 600. The mean ADC values of type 4 hepatic alveolar echinococcosis were compared with those of mass-forming type cholangiocarcinoma, in order to determine variations between the two. Differences in ADC between lesion types were determined by using an independent samples t-test and a statistically significant (P < 0.05) difference was observed. ResultsMean ADC values for IHCC were 1.24 ± 0.23 × 10−3 mm2/s, which was significantly lower than the 1.71 ± 0.23 × 10−3 mm2/s observed for HAE. These results supported the use of this technique as a mechanism for lesion differentiation. ConclusionsLower ADC in DW-MRI represents restricted diffusion. Due to multicellularity being higher in IHCC than HAE, the mean ADC values for IHCC were lower than for HAE.

Systematic review of feasibility, safety and efficacy of ex situ liver resection and autotransplantation

To evaluate the feasibility, safety and efficiency of ex situ liver resection (ESLR)technique in patients with hepatocaval region involvement. A systematic research of the data bases CNKI, Wan Fang, CQVIP, PubMed, CENTRAL, Medline, Embase, Cochrane, International Clinical Transplantation Registration Platform and Transplant Library was performed. All the current data regarding the feasibility, safety, and oncological efficiency of ESLR was systematically reviewed. Feasibility, conversion to allo-transplantation rate, complication and 90-day mortality were analyzed. A literature search revealed a total of 46 publications with 191 patients who underwent ex situ liver resection (101 autotransplantation, 90 ante-situm liver resection). The most common indication was hepatocellular carcinoma (49), followed by colorectal liver metastasis (37), hepatic alveolar echinococcosis (33) and cholangiocarcinoma (26). The feasibility rate was 84.5% (CI=76.6%-90.1%), the conversion to allo-transplantation rate was 13.5% (CI=8.5%-21.0%). Overall complication rate was 58.1% (CI=48.5%-67.1%), and complications grade Ⅲa or higher occurred in 43.1% (CI=33.6%-53.1%).90-day mortality was 19.5% (CI=12.7%-28.8%). ESLR and autotransplantation technique is an effective surgical approach for hepatic tumor with hepatocaval region involvement. Strict control of surgical indications, preoperative evaluation and precise surgical technique is essential to success.

Expression of Toll-like receptor 2, 4 and related cytokines in patients with hepatic cystic and alveolar echinococcosis

Expression of Toll-like receptor 2, 4 and related cytokines in patients with hepatic cystic and alveolar echinococcosis

Ultrasonographic findings of small lesion of hepatic alveolar echinococcosis

ObjectiveTo investigate the features of small lesions of hepatic alveolar echinococcsis paragonimiasis (AE) on conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging. MethodsThis retrospective study was approved by the Institutional Review Board, and the requirement for informed consent was waived. US and CEUS features of seventeen lesions histopathologically proven hepatic AE were retrospectively reviewed. Nine patients with seventeen hepatic AE lesions who were admitted to our hospital between January 2008 and June 2015 were enrolled. All hepatic AE lesions were small (≤3cm). The US and CEUS examinations were performed with a Philips IU22 scanner with a 1–5-MHz convex transducer. After US was completed, the CEUS study was performed. Pulse-inversion harmonic imaging was used for CEUS. A bolus injection of 2.4mL of a sulfur-hexafluoride-filled microbubble contrast agent (SonoVue) was administered. The features of the lesions by US and CEUS were retrospectively reviewed. ResultsIn total, all lesions were detected by US and CEUS. The mean size of the lesions was 1.8±0.7cm (range: 1.0–3.0cm). Five patients (55.6%, 5/9) had a lesion in the right hepatic lobe; two (22.2%, 2/9) had two lesions in the left hepatic lobe; and two patients (22.2%, 2/9) had four lesions in the right lobe. Seven lesions (41.2%, 7/17) were hypoechoic nodules and ten (58.8%, 10/17) were hyperechoic nodules. Nine lesions (52.3%, 9/17) were of mixed echogenicity type. Ten lesions (58.8%, 10/17) had a regular shape. Nine lesions (52.3%, 9/27) had a sharp margin and six (35.3%, 6/17) had indistinct margins. Four lesions (57.1%, 4/7) with hypoechoic nodule had small dotted calcifications, none was found in hyperechoic nodule. Seven nodules (41.2%, 7/17) showed short striated blood-flow signals surrounding the margin, on color Doppler flow imaging. By CEUS, All the lesions were hypoechoic with mixed content (). 12 lesions (70.1%, 12/17) were rim enhanced with irregular piece-like nonenhanced internal areas and showed nonhomogeneous hypo-enhancement during the arterial phase, with mixed echogenicity. The main pathological findings included: (1) (1) coagulative or liquefactive necrosis within the lesion with sporadic distribution of wizened alveolar hydatid cysts; and (2) hyperplasia of granulomatous and fibrous tissue around the lesion. ConclusionHyperechogenicity, mixed echogenicity type, dotted calcification with hypoechogenicity, sharp margin, rim enhancement and piece-like nonenhanced areas could be seen as the main ultrasonographic features of small lesion of hepatic alveolar echinococcosis.

Ex Vivo Liver Resection and Autotransplantation for End-Stage Alveolar Echinococcosis: A Case Series

The role of autotransplantation in end-stage hepatic alveolar echinococcosis (AE) is unclear. We aimed to present our 15-case experience and propose selection criteria for autotransplantation. All patients were considered to have unresectable hepatic AE by conventional resection due to critical invasion to retrohepatic vena cava, hepatocaval region along with three hepatic veins, and the tertiary portal and arterial branches. All patients successfully underwent ex vivo extended right hepatectomy and autotransplantation without intraoperative mortality. The median autograft weight was 706 g (380-1000 g); operative time was 15.5 hours (11.5-20.5 hours); and anhepatic time was 283.8 minutes (180-435 min). Postoperative hospital stay was 32.3 days (12-60 days). Postoperative complication Clavien-Dindo grade IIIa or higher occurred in three patients including one death that occurred 12 days after the surgery due to acute liver failure. One patient was lost to follow-up after the sixth month. Thirteen patients were followed for a median of 21.6 months with no relapse. This is the largest reported series of patients with end-stage hepatic AE treated with liver autotransplantation. The technique requires neither organ donor nor postoperative immunosuppressant. The early postoperative mortality was low with acceptable morbidity. Preoperative precise assessment and strict patient selection are of utmost importance.

How to not miss alveolar echinococcosis in hepatic lesions suspicious for cholangiocellular carcinoma.

Hepatic alveolar echinococcosis (AE) resembles intrahepatic cholangiocarcinoma (ICC) on radiological imaging. The purpose of this study was to identify criteria to discriminate AE from ICC with CT and MR Imaging. One hundred and sixteen imaging studies of 94 patients (CT n = 65; MRI n = 51) diagnosed with AE (n = 55) or ICC (n = 39) were retrospectively reviewed by two blinded radiologists for lesion features including enhancement pattern and matrix composition. A consensus read was conducted in cases of disagreement. Uni- and multivariate logistic regression with bootstrapping were used for analysis. Using CT, no or septal enhancement and calcification yielded the highest values of sensitivity/specificity (90.9%/90.6% and 81.8%/96.9%) for AE. Using MRI, no or septal enhancement and cystic components achieved the highest sensitivity/specificity (90.9%/100.0% and 84.8%/66.7%) for AE. Multivariate logistic regression identified the following strong independent predictors for AE: for MRI, no or septal enhancement (odds ratio [OR] 322.4; p < 0.001); for CT, no or septal enhancement and calcification (OR 35.9 and 42.5; p < 0.001 and p < 0.01, respectively). No or septal enhancement and calcification demonstrated the highest interreader agreement (>90%). Enhancement characteristics and matrix calcifications offer the strongest discriminating potential between AE and ICC with a high sensitivity, specificity, and interreader agreement.

Proposal of a computed tomography classification for hepatic alveolar echinococcosis.

To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study. The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis (AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography (PET)-CT examinations were evaluated. The diagnosis of AE was made in patients with unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme. Within the classification a lesion was dedicated to one out of five "primary morphologies" as well as to one out of six "patterns of calcification". "primary morphology" and "pattern of calcification" are primarily focussed on separately from each other and combined, whereas the "primary morphology" V is not further characterized by a "pattern of calcification". Based on the five primary morphologies, further descriptive sub-criteria were appended to types I-III. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type IV primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria. The proposed CT-morphological classification (EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.

Efficacy of ultrasound-guided core-needle biopsy in the diagnosis of hepatic alveolar echinococcosis: a retrospective analysis

Background: This study retrospectively analyzed the clinical data, laboratory results, imaging findings, and histopathological features of 28 patients who underwent ultrasound-guided core-needle biopsy from a hepatic lesion and were diagnosed with alveolar echinococcosis. Results: Among 28 patients included in the study, 16 were females and 12 were males. The mean age of the studied population was 53 ± 16 years, and the age range was 18–79 years. The most common presenting symptom was abdominal pain, which was observed in 14 patients. A total of 36 lesions were detected in the patients’ livers, out of which 7 had a cystic appearance. Hepatic vascular involvement, bile duct involvement, and other organ involvement were depicted in 14, 5, and 7 patients, respectively. The average number of cores taken from the lesions was 2.7, ranging between 2 and 5. In histopathological evaluation, PAS+ parasitic membrane structures were visualized on a necrotic background in all cases. Regarding seven patients, who were operated, the pathological findings of preoperative percutaneous biopsies were in perfect agreement with the pathological examinations after surgical resections. None of the patients developed major complications after biopsy. Conclusion: Ultrasound-guided core-needle biopsy is a minimally invasive, reliable, and effective diagnostic tool for the definitive diagnosis of hepatic alveolar echinococcosis.

Evaluation the activity of alveolar echinococcosis: A comparison between 18F-FDG PET and spectral CT

PurposeTo assess the iodine concentration of hepatic alveolar echinococcosis (HAE) using spectral computed tomography (CT) with comparison of [18F] fluorodeoxyglucose positron-emission tomography (18F-FDG PET), and to estimate the value of spectral CT for evaluation of HAE activity. Materials and methods18 patients with histologically confirmed or clinically proved HAE underwent spectral CT and 18F-FDG PET examinations. After three-phase scanning, the quantitative iodine-based material decomposition images and optimal monochromatic image of spectral CT were reconstructed and iodine concentration (IC) was measured in different organizational structures. Results18F-FDG PET identified increased metabolic activity in the corresponding lesions in 13 patients (13/18, 72.2%). The iodine concentration in marginal zone of lesion were significantly higher than in solid component of lesion and normal liver parenchyma during PVP and VP. The iodine value of edge tissue of the lesion and normal liver and iodine value of normal liver tissues showed statistically significant difference (P < 0.001). There was correlation between IC and SUVmax in marginal zone of HAE lesion, it was highest during PVP (r = 0.873, p < 0.001). There was low correlation between CT values and SUVmax. ConclusionThere was good correlation between spectral CT and 18F-FDG PET. Spectral CT could be recommended as a more practical tool in the clinical routine.

Analysis of the clinical value of 18F-FDG PET/CT in hepatic alveolar echinococcosis before and after autologous liver transplantation.

The aim of this study was to evaluate the clinical value of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in advanced liver alveolar echinococcosis (LAE) prior to and following autologous liver transplantation (ALT). The biodistribution of lesions in 8 patients was recorded using 18F-FDG PET/CT prior to and following surgery. The maximum standardized uptake value (SUVmax) of the lesions was also measured and compared with the pathological results. The overall hepatic peri-lesion SUVmax of the patients was 3.57±1.21, and the delayed SUVmax was 4.19±1.70. The diagnostic sensitivity of 18F-FDG PET/CT in LAE was 91.67%, with a specificity of 60.00% and accuracy of 82.35%. The positive predictive value was 84.62%, and the negative predictive value was 75.00%. SUVmax values of the surviving liver were 1.23±0.78 after 1 month, 1.15±0.67 after 3 months and 0.85±0.35 after 6 months. Compared with normal liver values (0.95±0.19), the 1-month SUVmax was significantly different. The SUVmax in 3 patients with high-lividity lesions was 2.05±0.72, and the delayed SUVmax was 3.15±0.83; 3 months after transplantation, the SUVmax was 1.85±0.62, and the delayed SUVmax was 2.95±0.79, revealing no significant difference. In conclusion, 18F-FDG PET/CT is effective for determining the biological boundary of LAE and shows important clinical value in determining the metabolic activities of the surviving liver following ALT.