Hepatic Cystic Echinococcosis Research Articles

Development of an improved anesthesia protocol to increase CF1 mice survival in a portal vein infection with Echinococcus granulosus sensu lato protoscoleces

In order to optimize the survival rate of animals, the purpose of this study was to evaluate an injectable anesthesia protocol for the development of a murine model of hepatic cystic echinococcosis in female CF-1 mice. Three protocols of injectable anesthesia were evaluated during the infection of mice with Echinococcus granulosus sensu lato protoscoleces via the portal vein. The use or not of pre-anesthesia [atropine (0.4 mg/kg) and tramadol (2 mg/kg)] and the incorporation or not of yohimbine (0.5 mg/kg) (a reverser of xylazine) in mice anesthetized with ketamine/xylazine 80/8 mg/kg were evaluated. Most mice treated only with ketamine/xylazine 80/8 mg/kg did not achieve a deep surgical anesthetic plane. All mice treated with pre-anesthetic drugs achieved a deep surgical anesthetic plane after the administration of the anesthetic cocktail. Pre-anesthetic drugs application significantly reduced time induction of animals compared with those that received only anesthetic cocktail. Recovery time was significantly faster in the group that received yohimbine. Mice underwent laparotomy that did not receive yohimbine after surgery had a survival rate of 67%, whereas in the group treated with yohimbine the survival was 100 %. We recommend the protocol that applied pre-anesthetic drugs + ketamine/xylazine 80/8 mg/kg + yohimbine, as safe and reliable for the portal vein infection of mice with protoscoleces of E. granulosus sensu lato.

Evaluation of Nine Commercial Serological Tests for the Diagnosis of Human Hepatic Cyst Echinococcosis and the Differential Diagnosis with Other Focal Liver Lesions: A Diagnostic Accuracy Study.

The differential diagnosis of hepatic cystic echinococcosis (CE) may be challenging. When imaging is insufficient, serology can be applied, but no consensus diagnostic algorithm exists. We evaluated the performances of nine serological tests commercialized in Europe for the diagnosis of “echinococcosis”. We performed a diagnostic accuracy study using a panel of sera from patients with hepatic CE (n = 45 “liquid” content stages, n = 25 “solid” content stages) and non-CE focal liver lesions (n = 54 with “liquid” content, n = 11 with “solid” content). The diagnosis and staging of CE were based on ultrasound (gold standard). Nine commercial seroassays (5 ELISA, 2 WB, 1 Chemiluminescence Immunoassay [CLIA] and 1 Immunochromatographic test [ICT]) were the index tests. Sensitivity (Se) ranged from 43 to 94% and from 31 to 87%, and specificity (Sp) from 68 to 100% and from 94 to 100%, when borderline results were considered positive or negative, respectively. Three seroassays (2 ELISA, 1 WB) were excluded from further analyses due to poor performances. When tests were combined, Sp was 98–100%. The best results were obtained using the WB-LDBIO alone (Se 83%) or as a third test after two non-WB tests (Se 67–86%). A validated WB or two non-WB tests, read with stringent criteria (borderline = negative and considered positive only if concordant positive), possibly confirmed by the WB, appear sensible approaches.

Double versus single T-tube drainage for frank cysto-biliary communication in patients with hepatic cystic echinococcosis: a retrospective cohort study with median 11\xa0years follow-up

BackgroundPartial peri-cystectomy (PPC) is one of the major surgical approaches for hepatic cystic echinococcosis (CE) and has been practiced in most centers worldwide. Cysto-biliary communication (fistula, leakage, rupture) is a problematic issue in CE patients. T-tube is a useful technique in situations where an exploration and decompression are needed for common bile duct (CBD). However, postoperative biliary complications for cystic cavity still remains to be studied in depth.MethodsA retrospective cohort analysis of CE cases in our single center database from 2007 March to 2012 December was performed. Patients (n = 51) were divided into two cohorts: double T-tube drainage (one at CBD for decompression and one at the fistula for sustaining in cystic cavity, n = 23) group and single T-tube drainage cohort (only one at CBD for decompression, n = 28). Short-/long-term postoperative complications focusing on biliary system was recorded in detail and they were followed-up for median 11 years.ResultsOverall biliary complication rates for double and single T-tube drainages were 17.4% vs. 39.3% (P > 0.05). Short-term complications ranged from minor to major leakages, cavity infection and abscess formation, and prevalence was 17.4% vs. 21.4% (P > 0.05) respectively for double and single T-tube groups; most importantly, double T-tube drainage group had obvious advantages regarding long-term complications (P < 0.05), which was biliary stricture needing surgery and it was observed only in single T-tube drainage group.ConclusionsDouble T-tube drainage had better outcomes without procedure-specific postoperative biliary complications than single T-tube drainage. Meanwhile, we recommend long-term follow-up when comparing residual cavity related biliary complications in CE patients as it could happen lately.

Diagnosis and treatment modalities of hilar biliary duct stricture in hepatic cystic echinococcosis after endocystectomy.

Aim: Hilar biliary duct stricture may occur in hepatic cystic echinococcosis (CE) patients after endocystectomy. This study aimed to explore diagnosis and treatment modalities. Methods: Clinical data of 26 hepatic CE patients undergoing endocystectomy who developed postoperative hilar biliary duct stricture were retrospectively analyzed and were classified into three types: type A, type B, and type C. Postoperative complications and survival time were successfully followed up. Results: Imaging showed biliary duct stenosis, atrophy of ipsilateral hepatic lobe, reactive hyperplasia, hepatic hilum calcification, and dilation or discontinuity of intrahepatic biliary duct. All patients received partial hepatectomy to resect residual cyst cavity and atrophic liver tissue, and anastomosis of hepatic duct with jejunum or common bile duct exploration was applied to handle hilar biliary duct stricture. Twenty-five patients were successfully followed up. Among type A patients, one patient died of organ failure, and upper gastrointestinal bleeding and liver abscess occurred in one patient. Moreover, calculus of intrahepatic duct was found in one type B and type C patient. Conclusion: Long-term biliary fistula, infection of residual cavity or obstructive jaundice in hepatic CE patients after endocystectomy are possible indicators of hilar bile duct stricture. Individualized and comprehensive treatment measures, especially effective treatment of residual cavity and biliary fistula, are optimal to avoid serious hilar bile duct stricture.

Evaluation of Usefulness of Three Serological Tests Using Native Crude Antigen in Diagnosis of Hepatic Cystic Echinococcosis Patients

Objective: To evaluate three different serological tests [Indirect Hemaglutination (IHA), Enzyme Linked Immunosorbent Assay (ELISA) and Western Blotting (WB)] using native crude antigen for diagnosis of hepatic cystic echinococcosis (HCE) patients. Materials and Methods: Sheep hydatid fluid (HF) was collected from fertile cysts obtained from a slaughterhouse and used as an antigen. Forty patients who were attended the Dr. Ersin Arslan Training and Research Hospital in Gaziantep, Turkey, were investigated. Serum samples were obtained from surgically confirmed CE patients. Healthy Turkish people and 16 patients with other helminthic infections were included as a control group. Results: Of the 40 analyzed patients, 10 (25%) were men and 30 (75%) were female. The average age was 46.97 years (s.d.; 18.95). The majority of the patients had a single cystic lesion situated in one lobe of the liver (usually in the right lobe) (55%), 32.5% of patients had two cystic lesions and 12.5% of patients had multiple cyst formations with various numbers. In all cases, ultrasound (US) examinations were positive and the size of cysts was between 2.1 - 12.7 cm. Twenty-three patients of the total 40 patients were classified according to the WHO classification system based on US findings. According to the results of WB analysis, molecular weights of 8 kDa (80%), 12 kDa (80%), 22 - 24 kDa (97.5%), 26 kDa (97.5%), 34 kDa (100%), 36 - 38 kDa (90%), 45 - 50 - 55 kDa (97.5%), and 60 - 75 kDa (97.5%) bands were identified. But 34, 50, and 55 kDa bands were also found in other helminthic diseases. Conclusion: The specificity and sensitivity of three serological tests (IHA, ELISA and WB) using crude antigen were compared by diagnosing hepatic cystic echinococcosis patients. IHA and ELISA showed high sensitivity but low specificity. Western blotting showed low sensitivity but high specificity.

Laparoscopic management of Hepatic cystic echinococcosis in Nepal: A single center experience

Introduction: Advances in laparoscopy has replaced many conventional open surgeries; hepatic cystic echinococcosis (CE) surgery is no exception. This study aims to evaluate the feasibility, postoperative outcomes including complications and recurrence rates after employing laparoscopic treatment for hepatic CE.&#x0D; Methods: This is a prospective study involving patients who underwent laparoscopic intervention for Hepatic CE at Nepal Medical College and Teaching Hospital from 1st July 2014 to 30th June 2019. Laparoscopic partial pericystectomy was done through the Palanivelu hydatid system and technique after pretreatment with albendazole (10mg/kg) for at least one week. Clavien-Dindo classification was used to classify postoperative complications.&#x0D; Results: Twenty-two patients were enrolled in the study with a mean age of 33.95±15.24 (18.0-75.0) years, 15 (68.18%) of them being female. Abdominal pain (77.3%) was the commonest complaint and a single cyst in the right lobe of the liver was the commonest pathology. The mean size of the cyst was 10.2±3.0 (5.0-15.0) cms. 40.9% of the cysts belonged to WHO-IWGE Grade CE3, while grade CE2 and CE1 consisted of 27.3% each. The mean operation time was 80.7 ± 19.7 (60-120) minutes. Out of the 22 patients, six (27.3%) had minor grades while four (18.2%) had major grades of Clavien-Dindo complications. Among the major complications, one (4.5%) patient each developed biliary fistula managed with ERCP and stenting, recurrence after three months, intraoperative bleeding requiring conversion to open surgery, and acute kidney injury managed with dialysis. There was no anaphylaxis or operative mortality.&#x0D; Conclusion: In selected patients, laparoscopic treatment for hepatic CE is feasible even in a resource-limited country like Nepal. With a low rate of conversion, recurrence and mortality, laparoscopic management can be safe, effective and encouraging treatment modality for the patients of hepatic CE.

The application of laparoscopy combined with indocyanine green fluorescence imaging technique for hepatic cystic echinococcosis

BackgroundWith the mature application of laparoscopy in hepatobiliary surgery, laparoscopic treatment of hepatic cystic echinococcosis (CE) has made certain progress. But, due to the inherent limitations of laparoscopy and the growth characteristics of cystic echinococcosis, distinguishing the boundary between cystic lesion and normal hepatic parenchyma is pivotal importance for successful surgery. Indocyanine green (ICG) fluorescence imaging technology can view the boundary of lesion and normal tissue during the treatment of hepatic cystic echinococcosis. Applied laparoscopy combined with ICG fluorescence imaging technique for hepatic cystic echinococcosis may be an effective surgical strategy.MethodsThe clinical data contained nine patients with hepatic cystic echinococcosis who underwent laparoscopic surgery with indocyanine green fluorescence imaging technique in authors’ institution from December 2018 to December 2019 were retrospectively analyzed. Indocyanine green was administered intravenously three days prior to surgery. The fluorescence acquisition system for real-time imaging was used during the surgery and the patients were followed up after surgery.ResultsOf reported nine patients, six are male and the remaining three are female. The average age is (36.4 ± 7.6) years. For all subjects, surgical procedures were performed under laparoscopy with indocyanine green fluorescence system. This technique showed the clear boundary of the hepatic cyst with normal liver parenchyma. Total cystectomy in six patients, subtotal cystectomy in two patients and partial hepatectomy in one patient were performed respectively. The average operation time was 3.8 ± 0.9 h, blood loss 206.0 ± 120.7 ml. Neither blood transfusion nor post-operative complication was experienced. The average abdominal drainage time was 3.4 ± 0.9 days with hospital stay 5.7 ± 2.1 days. During the 6–12 months follow-up period, neither recurrence nor intraperitoneal implantation was found.ConclusionsApplied laparoscopy combined with ICG fluorescence imaging technique for hepatic cystic echinococcosis is safe and feasible. Enhanced boundary image can assist surgeons to complete radical resection and reduce complications.

Nomogram Analysis and Internal Validation to Predict the Risk of Cystobiliary Communication in Patients Undergoing Hydatid Liver Cyst Surgery

PurposeBiliary leakage caused by cystobiliary communication (CBC) is a common clinical concern. This study sought to identify predictors of CBC in hepatic cystic echinococcosis (HCE) patients undergoing hydatid liver cyst surgery and establish nomograms to predict CBC.MethodsA predictive model was established in a training cohort of 310 HCE patients diagnosed between January 2013 and May 2017. Upon revision of the records of clinical parameters and imaging features of these patients, the lasso regression model was used to optimize feature selection for the CBC risk model. Combined with feature selection, a CBC nomogram was developed with multivariable logistic regression. C-index and calibration plots were used to analyze and evaluate the discrimination and calibration. The net benefit and predictive accuracy of the nomogram were performed via decision curve analysis (DCA) and receiver operating characteristic (ROC) curve. An independent validation cohort of 132 patients recruited from June 2017 to May 2019 was used to evaluate the practicability of the nomogram.ResultsPredictors contained four features, namely alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), cyst size and cyst location. The C-index of the nomogram is 0.791 (95% CI, 0.736–0.845), while the C-index verified by bootstrap is 0.746, indicating high prediction accuracy. The area under the curve (AUC) of the CBC in training was 0.766. ROC curve analysis demonstrated high sensitivity and specificity. Decision curve analysis confirmed the CBC nomogram was clinically useful when the intervention was determined at the non-adherence possibility threshold of 8%.ConclusionThe nomogram developed using the ALP, GGT, cyst size and cyst location could be used to facilitate the CBC risk prediction in HCE patients.

Application of perioperative nutrition management strategy in patients with hepatic cystic echinococcosis

Objective To explore the application of perioperative nutrition management strategy in patients with hepatic cystic echinococcosis. Methods From October 2017 to February 2019, 53 patients with hepatic cystic echinococcosis who met the inclusion criteria were selected as the control group. Another 53 patients from June 2018 to January 2019 were collected as the experimental group, the nutritional index, liver function, complication rate and postoperative recovery were compared between the two groups. Results The levels of retinol-binding protein, prealbumin and transferrin were (24.32 ± 3.76) μg/L, (167.00 ± 24.12) mg/L, (2.08 ± 0.43) μg/L on the day of admission in the experimental group, and one day before the operation were (27.78± 4.98) μg/L, (245.00 ± 22.02) mg/L,(2.47 ± 0.54)μ g/L, there was no significant difference (t=0.576-3.552, P < 0.05). The incidence of infection, biliary leakage and hemorrhage in the experimental group were 0, 1.89% (1/53) and 0 respectively, which were lower than 9.43% (5/53), 13.21% (7/53), 11.32% (6/53) in the control group (χ2 value was 4.867, P < 0.05). The aspartate aminotransferase and alanine aminotransferase of the experimental group on the 7th day after operation were (51.50 ± 6.30), (29.54 ± 2.03) U/L, which were significantly different from (69.53 ± 7.07), (43.72±3.67) U/L of the control group (t value was 2.032, 2.015, P<0.05). Anal exhaust, defecation time, hospitalization time and expenses in the experimental group were (15.89±8.34) h, (49.12±10.56) h, (8.69 ± 1.69) d, (2.84±1.37) thousand yuan, which were significantly different from (34.13±7.13) h, (63.45±11.03) h, (11.51±4.18) d, (3.76±1.53) thousand yuan in the control group. There was statistical significance (t values were 3.372-12.592, P<0.05). Conclusions The application of perioperative nutrition management strategy in patients with hepatic cystic echinococcosis can improve the nutritional status of patients during perioperative period, promote the recovery of liver function and reduce the occurrence of postoperative complications. Key words: Hepatic cystic echinococcosis; Perioperative period; Nutrition management

An integrated surgical training program for hepatic cystic echinococcosis in Xinjiang of China.

BackgroundHuman cystic echinococcosis (CE) is one of the commonest zoonoses, and it is endemic in many parts of the world including China. Complications and recurrences after the surgical treatment of hepatic CE (HCE) incur a large personal, healthcare, and societal burden. There has been some progress in HCE prevention, diagnosis, and treatment, but there is no “one size fits all” approach, and surgery still remains the cornerstone of treatment for some cyst stages and locations or in areas with little knowledge or access to other treatment modalities. In 2009 we designed and implemented a program to improve surgical outcomes from HCE in Xinjiang province, China.Methodology/Principal findingsA multimodal HCE training program was implemented in eleven primary hospitals in Xinjiang province, China, which provided education and training on HCE clinical knowledge and practice, the application of diagnostic and treatment options, and optimal surgery. The management of HCE cases was analyzed before and after program implementation. Contrast enhanced CT use, application of scoloicidal agents, removal of necrotic cyst wall remnants, appropriate perioperative drug use, and the use of optimal surgical approach increased after program implementation. Further, postoperative recurrences and residual cavity complications creased from 7.4% to 1.3% and 15.2% to 9.0% after program implementation, respectively.Conclusions/SignificanceTis integrated surgical training program is useful for improving outcomes of patients with HCE and can be used in institutions in other endemic areas.

Soluble ST2 (sST2) as potential marker for hepatic cystic echinococcosis activity

Objectivesthis study aims to identify the potential marker for hepatic cystic echinococcosis (CE) activity. Methodstotally 97 CE patients and 47 health control (HC) subjects were included. Based on the ultrasound (US) images, CE patients were further categorized as active CE (ACE; 52 cases) and inactive CE (IACE; 45 cases). The sST2 and IL (interleukin)-33 levels were measured by enzyme-linked immunosorbent assay. Univariate, multivariate and subgroup analysis were performed. The relationship between sST2 and CE activity was analyzed by the smooth curve fitting. The receiver operating characteristic (ROC) curve analysis was also performed. Resultsthe serum sST2 level in the CE patients was significantly higher than the HC subjects. Moreover, there was significant difference in the serum sST2 level between the ACE and IACE group. However, no significant difference was observed in the IL-33 level between the ACE and IACE groups. Univariate analysis showed that CE activity was significantly correlated with the sST2 level when the sST2 was greater than 1496.6 pg/mL. Multivariable analysis after adjustment for potential confounding factors, and subgroup analysis showed that sST2 had independent effect on CE activity. ROC curve showed that sST2 could differentially diagnose CE activity at the cut-off value of 1246.550 pg/mL with an AUC of 0.770. Conclusionthe sST2 could be used as a biomarker for hepatic CE activity. High levels of sST2 suggest that the hepatic CE is more likely to be active. Our findings have important guiding significance for the diagnosis of CE activity and the choice of treatment methods.

Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis

Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis

Treatment of Hepatic Cystic Echinococcosis Patients with Clear Cell Renal Carcinoma: A Case Report.

Human cystic echinococcosis is a zoonosis caused by the larval cestode Echinococcus granulosus. Clear cell renal carcinoma is the most common pathological type of renal cell carcinoma. Echinococcosis complicated with carcinoma is rarely reported. Here, we reported a female patient with echinococcal cyst of the liver accompanied with clear cell renal carcinoma. This 27-year-old woman was admitted for abdominal pain. The serological testing of hydatid cyst was positive and levels of tumor markers were within the normal range. The computed tomography and histological findings confirmed hepatic echinococcal cyst complicated with renal carcinoma of kidney. Preoperative liver function was grade A. The patient underwent pericystectomy of liver hydatid cyst and partial nephrectomy. No recurrence was found at 1 year of follow-up. Liver hydatid complicated with renal cell carcinoma is rare, which should be differentiated from liver metastasis of renal cancer. Surgical resection is the optimal treatment. This case may provide insight for the diagnosis and research on the co-occurrence of tumor and hydatid cyst.

Study on the association between TGF-β1 and liver fibrosis in patients with hepatic cystic echinococcosis.

The present study aimed to determine the role of the cytokine transforming growth factor-β1 (TGF-β1) in liver fibrosis among patients with hepatic cystic echinococcosis (hepatic CE). Hepatic tissue specimens and serum samples from 30 patients with hepatic CE were collected and TGF-β1 levels were compared between the two groups. The degree of liver fibrosis was assessed by Masson staining. The expression levels of cytokine TGF-β1 in liver tissue and serum were detected by immunohistochemistry and ELISA, respectively. Masson staining of liver lesion tissue in patients with hepatic CE indicated different degrees of fibrosis in the liver and the World Health Organization classification was positively correlated with the severity of liver fibrosis (P<0.05). In addition, the expression of cytokine TGF-β1 was higher in liver lesion tissue specimens compared with that in the adjacent control samples (P<0.05). At the same time, cytokine TGF-β1 in serum specimens of patients was higher than that in the healthy control group (P<0.05). In conclusion, the expression of TGF-β1 is upregulated in patients with hepatic CE, which was closely associated to liver fibrosis.

Diagnostic Performances of Commercial ELISA, Indirect Hemagglutination, and Western Blot in Differentiation of Hepatic Echinococcal and Non-Echinococcal Lesions: A Retrospective Analysis of Data from a Single Referral Centre.

The diagnosis of cystic echinococcosis (CE) is based on imaging. Serology supports imaging in suspected cases, but no consensus exists on the algorithm to apply when imaging is inconclusive. We performed a retrospective analysis of serology results of patients with untreated hepatic CE and non-CE lesions, seen from 2005 to 2017, to evaluate their accuracy in the differential diagnosis of hepatic CE. Serology results of three seroassays for echinococcosis (ELISA RIDASCREEN, indirect hemagglutination (IHA) Cellognost, and Western blot LDBIO) and clinical characteristics of eligible patients were retrieved. Patients were grouped as having active or inactive CE and liquid or solid non-CE lesions. Sensitivity, specificity, and diagnostic accuracy were compared between scenarios encompassing different test combinations. Eligible patients included 104 patients with CE and 257 with non-CE lesions. Sensitivity and diagnostic accuracy of Western blot (WB) were significantly higher than those of the following: 1) IHA or ELISA alone, 2) IHA+ELISA interpreted as positive if both or either tests positive, and 3) IHA+ELISA confirmed by WB if discordant. The best performances were obtained when WB was applied on discordant or concordant negative IHA+ELISA. Analyses performed within "active CE (n = 52) versus liquid non-CE (n = 245)" and "inactive CE (n = 52) versus solid non-CE (n = 12)" groups showed similar results. Specificity was high for all tests (0.99-1.00) and did not differ between test combination scenarios. WB may be the best test to apply in a one-test approach. Two first-level tests confirmed by WB seem to provide the best diagnostic accuracy. Further studies should be performed in different settings, especially where lower test specificity is likely.

Standardized Endocystectomy Technique for Surgical Treatment of Uncomplicated Hepatic Cystic Echinococcosis

Al-Saeedi, Mohammed MD; Khajeh, Elias MD; Ghamarnejad, Omid MD; Mehrabi, Arianeb MD, FACS Author Information

A study on the clinical outcomes using different laparoscopic methods to treat hepatic cystic hydatidosis

Objective To study the clinical outcomes using laparoscopic complete dissection of cysts, subtotal cystectomy and partial hepatectomy in the treatment of hepatic cystic echinococcosis. Methods A retrospective study was conducted on 40 patients with hepatic cystic echinococcosis treated by laparoscopic surgery from January 2014 to June 2018 at the First Affiliated Hospital of Xinjiang Medical University. According to the different surgical methods, these patients were divided into three groups: group A (n=14): the laparoscopic complete capsulectomy group, group B (n=14): the laparoscopic subtotal capsulectomy group, group C (n=12): the laparoscopic partial hepatectomy group. The operation time, intraoperative blood loss, time to pass first flatus, duration of drainage tube placement, days of hospitalization after operation, hospitalization expenses, complications of the residual cavity and local recurrence were compared among the 3 groups. Results In this study, all the 40 patients with hepatic cystic hydatidosis were cured, and no death occurred during the perioperative period. The intraoperative blood loss, postoperative duration of drainage tube placement, and hospitalization cost of the three groups were significantly the highest in group C (all P<0.05). The operative time and the time to pass first flatus in group C were both significantly greater than group B (P<0.05). The length of postoperative hospitalization in group A was significantly less than in group C (P<0.05). Postoperative recurrence and complications in group B were significantly worse than those in group A and group C (all P<0.05). Conclusion Laparoscopic complete dissection of the external capsule turned out to be the best laparoscopic treatment of hepatic cystic echinococcosis, followed by laparoscopic partial hepatectomy. Open surgery should be considered in patients with lesions which are evaluated preoperatively to have difficulty in carrying out laparoscopic complete dissection of capsule or partial hepatectomy. Key words: Laparoscopes; Echinococcosis, hepatics; Complete exocystectomy of hepatic hydatid; Hepatic hydatid outer sac subtotal resection; Hepatectomy

Clinical value of B-mode ultrasonography in the diagnosis of hepatic cystic hydatid disease

Objective To study the clinical application value of B-ultrasound in the diagnosis of hepatic cystic hydatid disease. Methods From June 2017 to July 2017, 400 suspected patients with hepatic cystic hydatid disease in the Traditional Chinese Medicine Hospital of Zhoushan were screened in Tibet.All the patients were examined by CT and B-ultrasound.Two CT diagnostics experienced in CT diagnosis and two ultrasound doctors experienced in ultrasound diagnosis were selected to analyze the CT images, B-ultrasound images of the patients, and make the diagnosis.The results of operation or serological examination(clinical diagnosis) were used as the reference.The sensitivity, specificity and accuracy of CT, B-ultrasound in the diagnosis of hepatic cystic hydatid disease were calculated and compared.The consistency between CT, B-ultrasound diagnosis and clinical diagnosis of hepatic cystic hydatid disease was analyzed by consistency test.According to the results of clinical diagnosis, the patients with hepatic cystic hydatid disease were divided into simple cyst type, multiple cyst type, daughter cyst cysts type, cyst calcification type and cyst solid type.The diagnostic coincidence rate of CT, B-ultrasound for different types of hepatic cystic hydatid disease was compared. Results A total of 358 cases were confirmed as hepatic cystic echinococcosis by operation and serological examination, and the remaining 42 cases were confirmed as hepatic bubble echinococcosis.The sensitivity, specificity and accuracy of CT in the diagnosis of liver cystic echinococcosis were 94.13%, 83.33%, 93.00%, respectively, which were lower than those of B-ultrasound (98.88%, 97.62% and 98.75%) (χ2=11.978, 4.974, 16.720, all P 0.05). Conclusion B-ultrasound can accurately diagnose hepatic cystic hydatid disease and can be used as the first choice for diagnosis of hepatic cystic hydatid disease, and B-ultrasound can also differentiate different types of hepatic cystic hydatid disease.The diagnostic value is significant. Key words: Echinococcosis, hepatic; Liver disease, parasitic; Ulerasonograpny; Tomography, x-raycomputed; Diagnosis differential

Single-Center Study: Evaluating the Diagnostic Performance and Safety of Contrast-Enhanced Ultrasound (CEUS) in Pregnant Women to Assess Hepatic Lesions.

Ultrasound is an essential imaging tool for evaluating physiological and pathological fetal or maternal conditions during pregnancy. Published data is limited with respect to the application of CEUS during pregnancy. CEUS has already been safely applied for assessing uteroplacental blood flow, cesarean scar pregnancy and invasive placenta percreta. CT and MRI scans during pregnancy must be thoroughly evaluated due to harmful ionizing radiation and cerebral gadolinium deposition, respectively. The aim of the present retrospective single-center study is to assess the diagnostic performance and safety of CEUS during pregnancy to evaluate hepatic lesions of unknown entity. 6 pregnant patients who underwent CEUS between 2005 and 2014 (mean age: 32 years; mean weeks of pregnancy: 28 weeks) were included in this study. The applied contrast agent was a second-generation blood-pool agent (SonoVue®, Bracco, Milan, Italy). CEUS examinations were performed and interpreted by a single radiologist with experience since 2000 (EFSUMB Level 3). CEUS was safely performed on all included pregnant women without the occurrence of adverse fetal or maternal events. In the context of the present study, CEUS helped to safely differentiate hepatic metastases, focal nodular hyperplasia, atypical hemangioma, hepatic arteriovenous malformation and cystic echinococcosis. In two patients CEUS determined immediate therapy. Although not clinically approved in obstetrics so far, CEUS is a safe imaging modality which, in addition to B-mode and color Doppler ultrasonography, may be applied during pregnancy for further medical indications and to provide helpful information.

Standardized endocystectomy technique for surgical treatment of uncomplicated hepatic cystic echinococcosis.

BackgroundTwo surgical options are available for cystic echinococcosis (CE). The two principal approaches are radical (resection of the cyst) and conservative (evacuation of the cyst content and partial removal of the cyst capsule). Here, we describe a standardized endocystectomy technique for hepatic echinococcosis.Subjects and methodsTwenty-one patients (male/female: 4/3; median age: 28 years) with uncomplicated, isolated hepatic CE (cyst stages WHO CE1, 2, 3a, and 3b) that were treated with the standardized endocystectomy described in this paper. Before the operation and during the follow-up period (mean: 33.8 months, median: 24 months), patients underwent clinical and sonographical and/or magnetic resonance imaging assessment during regular visits managed by an interdisciplinary team.ResultsForty-seven cysts were treated with the standardized endocystectomy technique. The median number of cysts per patient was two (range: 1–8). Nine patients (43%) had a single cystic lesion. The median operation time was 165 minutes and the median intraoperative bleeding volume was 200 mL. The median hospital stay was nine days (range: 6–28 days). Morbidity (Clavien-Dindo III) occurred in four patients (19%). No mortality and no recurrence were found during the median follow-up time of 24 months.ConclusionsThe standardized endocystectomy technique presented is a safe procedure with acceptable morbidity, no mortality, and without recurrences in our patient series. Important components of our CE management are interdisciplinary patient care, adequate diagnostic work-ups, and regular pre- and postoperative visits, including long-term follow-up for early and reliable capture of recurrences.