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Zhang X, Suolang L, Ren Y, Wang Y, Jiang Y, Zhong X, Gou Z, Zhou W, Chen J, Li Y, Cai D. Can contrast-enhanced ultrasound differentiate the type of hepatic echinococcosis: cystic echinococcosis or alveolar echinococcosis? Parasit Vectors 2023; 16:131. [PMID: 37069610 PMCID: PMC10111660 DOI: 10.1186/s13071-023-05731-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/11/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Hepatic echinococcosis (HE) is a zoonotic disease caused by Echinococcus, and Echinococcus granulosus and E. multilocularis are the most common, causing cystic echinococcosis (CE) and alveolar echinococcosis (AE), respectively. Contrast-enhanced ultrasound (CEUS) is an imaging technique which has been recommended for identifying focal lesions in the liver. However, the effect of CEUS on the differentiation of hepatic echinococcosis type remains unclear. METHODS Twenty-five patients with 46 HE lesions confirmed by histopathology in our hospital from December 2019 to May 2022 were reviewed by conventional ultrasound (US) and CEUS examinations, respectively. After US was completed, the CEUS study was performed. A bolus injection of 1.0-1.2 ml of a sulfur hexafluoride-filled microbubble contrast agent (SonoVue®) was administered. The images and clips of the lesions by US and CEUS were reviewed retrospectively. The lesions detected using US were evaluated including the location, size, morphology, margin, internal echogenicity and the internal Doppler signal. The lesions detected using CEUS were evaluated including the enhancement degree, enhancement pattern and enhancing boundary in different phases. The diagnoses of lesions by US or CEUS were respectively recorded. By taking the histopathology as the gold standard, the paired Chi-square test was performed with statistical software (IBM SPSS; IBM Corp., Armonk, NY, USA), and the results of differentiation of HE type by US and CEUS were statistically analyzed. RESULTS A total of 46 lesions were involved in 25 patients, including 10 males (40.0%) and 15 females (60.0%) aged 15-55 (42.9 ± 10.3) years. By histopathology, 24 lesions of nine patients were diagnosed as CE and 22 lesions of 16 patients were diagnosed as AE. Among the 46 HE lesions, compared with histopathological examination, the accuracy rate was 65.2% and 91.3% in US and CEUS findings, respectively. Among the 24 CE lesions, 13 lesions were correctly differentiated by US, and 23 by CEUS. The difference between US and CEUS was statistically significant (Chi-square test, [Formula: see text] = 8.10, df = 23, P < 0.005). Among the total 46 HE lesions, 30 lesions were correctly differentiated by US, and 42 by CEUS. The difference between US and CEUS was statistically significant (Chi-square test, [Formula: see text] = 10.08, df = 45, P < 0.005). CONCLUSIONS CEUS is a more effective technique than US for differentiating the type of HE between CE and AE. It could be a reliable tool in the differentiation of HE.
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Affiliation(s)
- Xuhui Zhang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lamu Suolang
- Center of Disease Control and Prevention, Tibet Autonomous Region, Lhasa, 850002, China
| | - Yelei Ren
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yifei Wang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yong Jiang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaofei Zhong
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zehui Gou
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wu Zhou
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Juan Chen
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yongzhong Li
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Diming Cai
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Differentiation of hepatic alveolar echinococcosis with a hemangioma-like pattern compared to typical liver hemangioma using contrast-enhanced ultrasound: a pilot study. Infection 2023; 51:159-168. [PMID: 35776381 PMCID: PMC9879800 DOI: 10.1007/s15010-022-01866-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE Echinococcus multilocularis infects humans as a false intermediate host, primarily with intrahepatic manifestation. Incorrect diagnostic interpretation of these liver tumors, especially the hemangioma-like pattern, can lead to progressive disease. The aim of the study was to investigate the differentiation of typical hemangioma and a hemangioma-like pattern of E. multilocularis using contrast-enhanced ultrasound (CEUS). METHODS This prospective clinical pilot study comprised patients with hemangioma (n = 14) and patients with alveolar echinococcosis (AE) and hemangioma-like pattern (n = 7). Inclusion criteria were the detection of a liver lesion according to a hemangioma-like pattern on E. multilocularis Ulm classification-ultrasound (EMUC-US) and "confirmed" or "probable" AE according to WHO case definition. The comparison group had hepatic hemangioma with typical B-scan sonographic morphology. All participants underwent conventional and contrast-enhanced ultrasonography. RESULTS The patient group comprised five men (71.4%) and two women (28.6%) with a mean average age of 64.1 ± 11.2 years. The patient group with hemangioma comprised nine female subjects (64.3%) and five male subjects (35.7%) with a mean average age of 56.1 ± 12.0 years. Early arterial bulbous ring enhancement (p < 0.0001) and iris diaphragm phenomenon could only be visualized in the patients with hemangioma (p < 0.0001). Furthermore, the patients with hemangioma exhibited hyperenhancement in the late phase (p = 0.0003). In contrast, the patients exhibited typical early arterial rim enhancement (p < 0.0001) and, in the portal venous and late phase, complete or incomplete non-enhancement (black hole sign; p = 0.0004). CONSLUSION The behavior of hemangioma-like AE lesions and typical liver hemangiomas is significantly different on CEUS. AE should be considered as a possible differential diagnosis, especially in high-endemic areas.
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Wang X, Yang L, Chen L, Song T. Evaluation of the Metabolic Activity of the Infiltration and Proliferation Areas of Hepatic Alveolar Echinococcosis in Rats Using Contrast-Enhanced Ultrasound. Am J Trop Med Hyg 2022; 107:1185-1189. [PMID: 36315997 PMCID: PMC9768251 DOI: 10.4269/ajtmh.22-0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/17/2022] [Indexed: 12/30/2022] Open
Abstract
This study evaluated the value of contrast-enhanced ultrasound (CEUS) in assessing the metabolic activity of infiltration and proliferation areas of hepatic alveolar echinococcosis (HAE) in rats. CEUS was performed on Wistar rats with HAE. The average grayscale value of the HAE lesion in peripheral infiltration and proliferation areas (PIPAs) and the adjacent normal liver tissue was analyzed quantitatively. Contrast imaging was classified as highly increased enhancement, moderately increased enhancement, and equal or decreased enhancement. Microvessel density (MVD) in the PIPAs was classified as strongly positive, moderately positive, and weakly positive. The metabolic activity of HAE in the PIPAs was classified as high activity, moderate activity, and low activity according to the MVD classification results. The kappa test was combined with the metabolic activity level of the PIPAs to analyze the consistency of CEUS intensity and MVD. CEUS can score the metabolic activity of the infiltration and proliferation areas around HAE lesions, and provides a basis for clinical treatment and follow-up visits. CEUS could be used as a more economical and effective imaging option for evaluating the metabolic activity of HAE lesions.
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Affiliation(s)
| | | | | | - Tao Song
- Address correspondence to Tao Song, Department of Ultrasound, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Liyushan Rd., Urumqi 830000, People’s Republic of China. E-mail:
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Wang YX, Liu W, Sun ZY, Wu L, Xie XK, Liu B. Analysis of Ultrasonographic Characteristics of Early Hepatic Alveolar Echinococcosis. Front Surg 2022; 9:918138. [PMID: 35865038 PMCID: PMC9294286 DOI: 10.3389/fsurg.2022.918138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to investigate the ultrasonographic characteristics of early hepatic alveolar echinococcosis (HAE) and improve the qualitative diagnostic ability of sonographers. Methods The data of 80 positive cases of HAE screened and diagnosed by ultrasonography and serum immunology (33 males and 44 females with a mean age of 44.12 ± 14.31 y) were used in the study. The imaging characteristics of the lesions (i.e., intrahepatic distribution, shape, size, echo, blood flow, and growth characteristics) were analyzed retrospectively, and the ultrasonographic characteristics of early lesions were discussed in combination with their basic pathological changes. Results Patients with lesions of the proliferative infiltration type accounted for 57.5% (46/80), the fibrous calcification type accounted for 26.25% (21/80), the necrotic liquefaction type accounted for 6.25% (5/80), and the mixed type accounted for 10% (8/80). Patients with lesions involving the right lobe and the left lobe accounted for 76.25% (61/80) and 11.25% (9/80), respectively, and with lesions involving both the left and right lobes accounted for 12.5% (10/80). There were statistically significant differences in diameter between all types of lesions (n = 88; F = 5.926 and P = 0.004). Focal hyperechoic and diffuse heterogenous nodular changes were the main manifestations of early proliferative infiltration lesions. Conclusion Ultrasonography is extremely valuable in the diagnosis of early HAE. Capillary hemangioma-like changes and hailstorm sign are the main characteristics of early lesions of HAE, and calcification is a common concomitant sign.
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Affiliation(s)
- Yong-Xing Wang
- Department of Surgery, The 969th Hospital of the PLA Joint Logistics Support Force, Hohhot, China
| | - Wei Liu
- Department of Surgery, The 969th Hospital of the PLA Joint Logistics Support Force, Hohhot, China
| | - Zhan-Yong Sun
- Department of Surgery, The 969th Hospital of the PLA Joint Logistics Support Force, Hohhot, China
| | - Lan Wu
- Department of Ultrasound, The 969th Hospital of the PLA Joint Logistics Support Force, Hohhot, China
| | - Xian-Kun Xie
- Department of Ultrasound, Jiuzhi People’s Hospital, Zhiqingsongduo, China
| | - Bo Liu
- Department of Ultrasound, The 969th Hospital of the PLA Joint Logistics Support Force, Hohhot, China
- Correspondence: Bo Liu
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Schweizer M, Schmidberger J, Schlingeloff P, Kratzer W. Contrast-enhanced ultrasound (CEUS) in patients with metastasis-like hepatic alveolar echinococcosis: a cohort study. J Ultrasound 2022; 26:129-136. [PMID: 35597873 PMCID: PMC10063733 DOI: 10.1007/s40477-022-00688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/15/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Hepatic alveolar echinococcosis (HAE) of the metastasis-like pattern, according to the Echinococcus Ulm classification, is usually discovered as an incidental finding, and the diagnostic differentiation from "true metastases" is difficult. The aim of this study was to investigate whether lesions of the "metastasis-like pattern" in HAE show a typical contrast behavior that can be used for differentiation from metastasis in malignancies. METHODS This prospective clinical study included 11 patients with histologically confirmed HAE of the metastasis-like pattern (7 female and 4 male; mean age, 57.1 years; mean disease duration, 59.5 months), who had been examined by B-scan sonography and CEUS, from the National Echinococcosis Registry Germany. RESULTS On contrast-enhanced sonography, 11/11 reference lesions showed annular rim enhancement in the arterial and portal venous phases. Throughout the entire 4-min study period, none of the reference lesions showed central contrast enhancement-i.e., all exhibited a complete "black hole sign". A small central scar was seen in 81.8% of cases. CONCLUSION In clinically unremarkable patients with incidentally detected metastasis-like lesions of the liver, contrast-enhanced sonographic detection of rim enhancement without central contrast uptake (black hole sign) should be considered evidence supporting a diagnosis of hepatic alveolar echinococcosis with a rare metastasis-like pattern. This can help to differentiate HAE from metastases, especially in high-endemic areas.
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Affiliation(s)
- Melissa Schweizer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Patrycja Schlingeloff
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Yangdan CR, Wang C, Zhang LQ, Ren B, Fan HN, Lu MD. Recent advances in ultrasound in the diagnosis and evaluation of the activity of hepatic alveolar echinococcosis. Parasitol Res 2021; 120:3077-3082. [PMID: 34370071 DOI: 10.1007/s00436-021-07262-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022]
Abstract
Echinococcosis is a worldwide neglected zoonotic disease. Alveolar echinococcosis (AE) poses a more serious threat to life and health than cystic echinococcosis, and has been one of the world's most lethal chronic parasitosis. Assessment of metacestode activity status is essential for individual treatment strategy design for a given AE patient, and fluorodeoxyglucose positron-emission tomography (FDG-PET) has been the gold standard. In this study, we reviewed previous evidence on AE activity assessment using contrast-enhanced ultrasound (CEUS), and its comparison with FDG-PET. The results showed good consistency between them, indicating CEUS as a suitable substitute for FDG-PET. With its advantage as being readily portable, widely available, and not costly, CEUS is more suitable for use in the developing countries and rural areas.
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Affiliation(s)
- Cai-Rang Yangdan
- Department of Hepatopancreatobiliary Surgery, the Qinghai University Affiliated Hospital; The Research Key Laboratory for Echinococcosis of Qinghai Province, Xining, China
| | - Cong Wang
- Department of Hepatopancreatobiliary Surgery, the Qinghai University Affiliated Hospital; The Research Key Laboratory for Echinococcosis of Qinghai Province, Xining, China
| | - Ling-Qiang Zhang
- Department of Hepatopancreatobiliary Surgery, the Qinghai University Affiliated Hospital; The Research Key Laboratory for Echinococcosis of Qinghai Province, Xining, China
| | - Bin Ren
- Department of Hepatopancreatobiliary Surgery, the Qinghai University Affiliated Hospital; The Research Key Laboratory for Echinococcosis of Qinghai Province, Xining, China
| | - Hai-Ning Fan
- Department of Hepatopancreatobiliary Surgery, the Qinghai University Affiliated Hospital; The Research Key Laboratory for Echinococcosis of Qinghai Province, Xining, China.
| | - Ming-De Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Zhu M, Du X, Xu H, Yang S, Wang C, Zhu Y, Zhang T, Zhao W. Metabolic profiling of liver and faeces in mice infected with echinococcosis. Parasit Vectors 2021; 14:324. [PMID: 34127037 PMCID: PMC8201681 DOI: 10.1186/s13071-021-04807-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
Background Echinococcosis is a severe zoonotic parasitic disease which severely affects the health of the hosts. The diagnosis of echinococcosis depends mainly on imaging examination. However, the patient is often in the late stage of the disease when the symptoms appear, thus limiting the early diagnosis of echinococcosis. The treatment and prognosis of the patients are hampered because of long-term asymptomatic latency. Metabolomics is a new discipline developed in the late 1990s. It reflects a series of biological responses in pathophysiological processes by demonstrating the changes in metabolism under the influence of internal and external factors. When the organism is invaded by pathogens, the alteration in the characteristics of metabolites in cells becomes extremely sensitive. Here, we used a metabolomics approach involving liquid chromatography coupled with tandem mass spectrometry (LC–MS/MS) to determine the molecular mechanism of cystic echinococcosis (CE) and to develop an effective method for CE diagnosis. Methods Twenty 8-week-old female BALB/c mice were divided into normal and Echinococcus granulosus infection groups. To develop the E. granulosus infection model, mice were infected with protoscoleces. Six weeks later, the abdomens of the mice showed significant bulging. An LC–MS/MS system-based metabolomics approach was used to analyse the liver and faeces to reveal the metabolic profiles of mice with echinococcosis. Results We found that the metabolism of nucleotides, alkaloids, amino acids, amides, and organic acids in mice is closely interrelated with E. granulosus infection. In the liver, the metabolic pathways of tyrosine and tryptophan biosynthesis; phenylalanine, valine, leucine and isoleucine biosynthesis; and phenylalanine metabolism were notably associated with the occurrence and development of hydatid disease, and in the faeces, pantothenate and CoA biosynthesis are thought to be closely associated with the development of CE. Conclusion The metabolomics approach used in this study provides a reference for a highly sensitive and specific diagnostic and screening method for echinococcosis. Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-021-04807-1.
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Affiliation(s)
- Mingxing Zhu
- Center of Scientific Technology of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,School of Basic Medical Science of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China
| | - Xiancai Du
- Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,School of Basic Medical Science of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China
| | - Hongxia Xu
- Center of Scientific Technology of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China
| | - Songhao Yang
- Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,School of Basic Medical Science of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China
| | - Chan Wang
- Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,School of Basic Medical Science of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China
| | - Yazhou Zhu
- Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,School of Basic Medical Science of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China
| | - Tingrui Zhang
- Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.,School of Basic Medical Science of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China
| | - Wei Zhao
- Center of Scientific Technology of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China. .,Key Laboratory of Hydatid Disease of Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, People's Republic of China.
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Lupia T, Corcione S, Guerrera F, Costardi L, Ruffini E, Pinna SM, Rosa FGD. Pulmonary Echinococcosis or Lung Hydatidosis: A Narrative Review. Surg Infect (Larchmt) 2020; 22:485-495. [PMID: 33297827 DOI: 10.1089/sur.2020.197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lung hydatidosis is a zoonosis related to infection by the Echinococcus tapeworm species. Lung involvement in this condition is second only to the liver echinococcosis. Diagnosis ordinarily results from an accidental finding in a direct chest radiograph evaluation because of the delayed growth of the cysts. Moreover, a consistent treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. In this review, we expect to sum up the main features of lung hydatidosis with a perspective on medical and surgical treatment. Methods: Cochrane Library and PubMed were the databases used to perform a narrative literature review. Search terms included "pulmonary echinococcosis" and "lung hydatidosis." The MeSH terms were "lung" [All Fields] AND {"echinococcosis" [MeSH Terms] OR ("hydatidosis" [All Fields] OR "pulmonary" [All Fields] AND "echinococcosis" [All Fields] OR "hydatidosis." A search period from September 1980 to May 2020 was chosen to compare studies from different decades, given the changes in pulmonary echinococcosis management. Results: A uniform treatment regimen or approach may not be feasible because of the variability of pulmonary echinococcosis. No clinical trials have analyzed and compared all the diverse treatment approaches. Cyst size, characteristics, position in the lung and clinical presentation, and the availability of medical/surgical expertise and equipment are the mainstays of echinococcosis management. When feasible, surgery is as yet the principal therapeutic choice to eliminate the cysts; anti-parasitic drugs may minimize complications during high-risk surgery or be used as definitive therapy in some instances with contraindications to surgery. Conclusions: Lung hydatidosis management must become less heterogeneous. We support treatment directed to the subject established on the clinical scenario, host factors, and surgical risk. Strict cooperation in this process between infectious disease specialists and surgeons may optimize best practices to help create shared practical guidelines to simplify clinicians' decision-making. Furthermore, we need a consensus for lung hydatidosis treatment and inserting this disease to global surgery agenda will have a positive impact on acquiring high-quality data that enables us to create an evidence-based guideline for this disease.
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Affiliation(s)
- Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco Guerrera
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Lorena Costardi
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Enrico Ruffini
- Department of Surgical Sciences, Università degli Studi di Torino, Turin, Italy
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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Wa ZC, Du T, Li XF, Xu HQ, Suo-Ang QC, Chen LD, Hu HT, Wang W, Lu MD. Differential diagnosis between hepatic alveolar echinococcosis and intrahepatic cholangiocarcinoma with conventional ultrasound and contrast-enhanced ultrasound. BMC Med Imaging 2020; 20:101. [PMID: 32854653 PMCID: PMC7453544 DOI: 10.1186/s12880-020-00499-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 08/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Misclassifications of hepatic alveolar echinococcosis (HAE) as intrahepatic cholangiocarcinoma (ICC) may lead to inappropriate treatment strategies. The aim of this study was to explore the differential diagnosis with conventional ultrasound and contrast-enhanced ultrasound (CEUS). METHODS Sixty HAE lesions with 60 propensity score-matched ICC lesions were retrospectively collected. The 120 lesions were randomly divided into a training set (n = 80) and a testing set (n = 40). In the training set, the most useful independent conventional ultrasound and CEUS features was selected for differentiating between HAE and ICC. Then, a simplified US scoring system for diagnosing HAE was constructed based on selected features with weighted coefficients. The constructed US score for HAE was validated in both the training set and the testing set, and diagnostic performance was evaluated. RESULTS Compared with ICC lesions, HAE lesions were mostly located in the right lobe and had mixed echogenicity, a pseudocystic appearance and foci calcifications on conventional ultrasound. On CEUS, HAE lesions showed more regular rim-like enhancement than ICC lesions and had late washout with a long enhancement duration. The simplified US score consisted of echogenicity, pseudocystic/calcification, bile duct dilatation, enhancement pattern, enhancement duration, and marked washout. In the testing set, the sensitivity, specificity, LR+, LR- and the area under the ROC curve for the score to differentiate HAE from ICC were 80.0, 81.3%, 4.27, 0.25 and 0.905, respectively. CONCLUSIONS The US score based on typical features from both conventional ultrasound and CEUS could accurately differentiate HAE from ICC.
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Affiliation(s)
- Zeng-Cheng Wa
- Department of Medical Ultrasonics, Qinghai Red Cross Hospital, Xining, China
| | - Ting Du
- Department of Medical Ultrasonics, Qinghai Red Cross Hospital, Xining, China
| | - Xian-Feng Li
- Department of Medical Ultrasonics, Qinghai Red Cross Hospital, Xining, China
| | - Hui-Qing Xu
- Department of Medical Ultrasonics, Qinghai Red Cross Hospital, Xining, China
| | - Qiu-Cuo Suo-Ang
- Department of Medical Ultrasonics, People's Hospital of Chengduo County, Yushu Prefecture, China
| | - Li-Da Chen
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China
| | - Ming-De Lu
- Department of Medical Ultrasonics, Ultrasomics Artificial Intelligence X-Lab, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China. .,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Corvino A, Sandomenico F, Setola SV, Corvino F, Tafuri D, Catalano O. Lesioni cistiche complex di fegato: reperti ecocontrastografici diagnostico-differenziali. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2020; 179. [DOI: 10.23736/s0393-3660.19.04120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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11
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Corvino A, Sandomenico F, Setola SV, Corvino F, Tafuri D, Catalano O. Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art. J Ultrasound 2019; 22:251-259. [PMID: 31087277 DOI: 10.1007/s40477-019-00385-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Complex cystic and cystic-like focal liver lesions (FLLs) encompass a spectrum of disorders ranging from non-neoplastic conditions to benign and malignant tumors. In this prospective, the possibility of non-invasive differentiation of these lesions is extremely important, because the clinical implications and therapeutic strategies vary considerably. Because of its advantageous cost/benefit ratio, widespread availability and easy execution, ultrasound (US) is the first-line imaging modality in most countries for the initial liver survey and represents the imaging technique that usually detects a complex liver cyst. However, US showed poor efficacy in the differential diagnosis of complex cystic FLLs. Thus, for years, computed tomography (CT) and magnetic resonance (MR) imaging have been used for further assessment of these lesions. Recently, the development of low mechanical index real-time contrast-enhanced ultrasound (CEUS) technique performed with the second generation of US contrast agents has led to an accurate depiction of macrovasculature and microvasculature. The technique yields information about contrast enhancement of the liver and FLLs almost as CT and MRI do, but in real time and without the use of ionizing radiation. To date, there is only a small amount of evidence about the role of CEUS in the less common setting of complex liver cysts. The aim of this review is to offer an up-to-date overview on the state of the art of CEUS in the study of the most common complex cystic focal liver lesions. To our knowledge, there are no literature comprehensive reviews on this topic.
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Affiliation(s)
- Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", VIA F. Acton 38, 80133, Naples, Italy.
- Advanced Biomedical Sciences Department, University Federico II of Naples (UNINA), Via S. Pansini 5, 80131, Naples, Italy.
- , via Croce no. 82, 81033, Casal di Principe, CE, Italy.
| | - Fabio Sandomenico
- Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131, Naples, Italy
| | - Sergio Venanzio Setola
- Radiology Department, National Cancer Institute Pascale Foundation, Via M. Semmola 53, 80131, Naples, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Domenico Tafuri
- Motor Science and Wellness Department, University of Naples "Parthenope", VIA F. Acton 38, 80133, Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, Via Cornelia Dei Gracchi 65, 80126, Naples, Italy
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12
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Wen H, Vuitton L, Tuxun T, Li J, Vuitton DA, Zhang W, McManus DP. Echinococcosis: Advances in the 21st Century. Clin Microbiol Rev 2019; 32:e00075-18. [PMID: 30760475 PMCID: PMC6431127 DOI: 10.1128/cmr.00075-18] [Citation(s) in RCA: 485] [Impact Index Per Article: 97.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Echinococcosis is a zoonosis caused by cestodes of the genus Echinococcus (family Taeniidae). This serious and near-cosmopolitan disease continues to be a significant public health issue, with western China being the area of highest endemicity for both the cystic (CE) and alveolar (AE) forms of echinococcosis. Considerable advances have been made in the 21st century on the genetics, genomics, and molecular epidemiology of the causative parasites, on diagnostic tools, and on treatment techniques and control strategies, including the development and deployment of vaccines. In terms of surgery, new procedures have superseded traditional techniques, and total cystectomy in CE, ex vivo resection with autotransplantation in AE, and percutaneous and perendoscopic procedures in both diseases have improved treatment efficacy and the quality of life of patients. In this review, we summarize recent progress on the biology, epidemiology, diagnosis, management, control, and prevention of CE and AE. Currently there is no alternative drug to albendazole to treat echinococcosis, and new compounds are required urgently. Recently acquired genomic and proteomic information can provide a platform for improving diagnosis and for finding new drug and vaccine targets, with direct impact in the future on the control of echinococcosis, which continues to be a global challenge.
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Affiliation(s)
- Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
| | - Lucine Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis and French National Centre for Echinococcosis, University Bourgogne Franche-Comte and University Hospital, Besançon, France
| | - Tuerhongjiang Tuxun
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Dominique A Vuitton
- WHO Collaborating Centre for Prevention and Treatment of Human Echinococcosis and French National Centre for Echinococcosis, University Bourgogne Franche-Comte and University Hospital, Besançon, France
| | - Wenbao Zhang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia and WHO Collaborating Centre for Prevention and Care Management of Echinococcosis, Urumqi, China
- Clinical Medical Research Institute, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Donald P McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Cai D, Li Y, Jiang Y, Wang H, Wang X, Song B. The role of contrast-enhanced ultrasound in the diagnosis of hepatic alveolar echinococcosis. Medicine (Baltimore) 2019; 98:e14325. [PMID: 30702614 PMCID: PMC6380766 DOI: 10.1097/md.0000000000014325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To evaluate the value of contrast-enhanced ultrasound (CEUS) compared with ultrasound (US) in the diagnosis of hepatic alveolar echinococcosis (AE).Thirty-one patients with 43 hepatic AE lesions between January 2010 and September 2017 were included in the study. All lesions which were histopathologically proven to be hepatic AE were retrospectively reviewed. Features of the lesions by CEUS were retrospectively studied.All lesions were detected by US and CEUS in the 31 patients (17 males and 14 females) with a mean age of 38.5 ± 10.6 years (range: 16-58 years). The size of the lesions ranged from 1.5 × 0.7 cm to 15 × 18 cm. By US, 3 lesions (7%, 3/43) were hypoechoic nodules, 21 (48.8%, 21/43) were hyperechoic, and 19 lesions (44.2%, 19/43) were of mixed echogenicity type (solid-cystic). 27 lesions (62.8%, 27/43) had calcifications. Only 1 lesion was detected blood-flow signals. With CEUS, 23 lesions (53.5%, 23/43) displayed no enhancement in the arterial phase, portal phase and delayed phase on CEUS. 11 lesions (25.6%, 11/43) displayed a slight ring-like hyper-enhancement in the arterial phase and displayed hypo-enhancement in the portal and delayed phase. 6 lesions (14%, 6/43) displayed hyper-enhancement in the arterial phase and hypo-enhancement in the portal and delayed phase. 2 lesions (4.7%, 2/43) showed iso-enhancement in the arterial, portal, and delayed phase. 1 lesion (2.3%, 1/43) showed slight hypo-enhancement in the arterial, portal, and delayed phase.CEUS is a more valid technique for diagnosing AE than US. It could be a reliable tool in the diagnosis of hepatic AE.
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Affiliation(s)
| | | | | | | | | | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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14
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Li J, Dong J, Yang L, Li X, Song T. Comparison of [ 18F]Fluorodeoxyglucose Positron Emission Tomography and Contrast-Enhanced Ultrasound for Evaluation of Hepatic Alveolar Echinococcosis Activity. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2199-2208. [PMID: 30077410 DOI: 10.1016/j.ultrasmedbio.2018.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 06/15/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
The mean gray-scale ratio of the infiltrating zone of a lesion to the surrounding normal liver tissue was evaluated on the basis of contrast enhancement of the infiltration and proliferation zones of a hepatic alveolar echinococcosis lesion. The results were compared with the maximum standardized uptake value (SUVmax) of [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET-CT), and the application of contrast-enhanced ultrasound in evaluating hepatic alveolar echinococcosis activity is discussed. The 36 patients with hepatic alveolar echinococcosis recruited underwent contrast-enhanced ultrasound and [18F]FDG PET-CT. A total of 39 lesions were found in the 36 patients. The results indicated that in 87.2% of the cases, the two methods yielded the same diagnosis, whereas in 12.8% of cases, the diagnoses obtained with the two methods were inconsistent. The statistical results revealed that contrast-enhanced ultrasound and [18F]FDG PET-CT have good inter-rater reliability in determining the activity of hepatic alveolar echinococcosis (κ = 0.756, p < 0.01).
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Affiliation(s)
- Juan Li
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Jian Dong
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Lei Yang
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Xiaohong Li
- Department of Nuclear Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tao Song
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, China.
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15
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Cai DM, Wang HY, Wang XL, Jiang Y, Luo Y, Li YZ. Ultrasonographic findings of small lesion of hepatic alveolar echinococcosis. Acta Trop 2017; 174:165-170. [PMID: 26892870 DOI: 10.1016/j.actatropica.2016.01.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/06/2016] [Accepted: 01/29/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the features of small lesions of hepatic alveolar echinococcsis paragonimiasis (AE) on conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) imaging. METHODS This 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. RESULTS In 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. CONCLUSION Hyperechogenicity, 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.
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Kern P, Menezes da Silva A, Akhan O, Müllhaupt B, Vizcaychipi KA, Budke C, Vuitton DA. The Echinococcoses: Diagnosis, Clinical Management and Burden of Disease. ADVANCES IN PARASITOLOGY 2017; 96:259-369. [PMID: 28212790 DOI: 10.1016/bs.apar.2016.09.006] [Citation(s) in RCA: 258] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The echinococcoses are chronic, parasitic diseases that are acquired after ingestion of infective taeniid tapeworm eggs from certain species of the genus Echinococcus. Cystic echinococcosis (CE) occurs worldwide, whereas, alveolar echinococcosis (AE) is restricted to the northern hemisphere, and neotropical echinococcosis (NE) has only been identified in Central and South America. Clinical manifestations and disease courses vary profoundly for the different species of Echinococcus. CE presents as small to large cysts, and has commonly been referred to as 'hydatid disease', or 'hydatidosis'. A structured stage-specific approach to CE management, based on the World Health Organization (WHO) ultrasound classification of liver cysts, is now recommended. Management options include percutaneous sterilization techniques, surgery, drug treatment, a 'watch-and-wait' approach or combinations thereof. In contrast, clinical manifestations associated with AE resemble those of a 'malignant', silently-progressing liver disease, with local tissue infiltration and metastases. Structured care is important for AE management and includes WHO staging, drug therapy and long-term follow-up for at least a decade. NE presents as polycystic or unicystic disease. Clinical characteristics resemble those of AE, and management needs to be structured accordingly. However, to date, only a few hundreds of cases have been reported in the literature. The echinococcoses are often expensive and complicated to treat, and prospective clinical studies are needed to better inform case management decisions.
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Affiliation(s)
- P Kern
- University Hospital of Ulm, Ulm, Germany
| | | | - O Akhan
- Hacettepe University, Ankara, Turkey
| | - B Müllhaupt
- University Hospital of Zurich, Zürich, Switzerland
| | - K A Vizcaychipi
- National Institute of Infectious Diseases, Buenos Aires, Argentina
| | - C Budke
- Texas A&M University, College Station, TX, United States
| | - D A Vuitton
- Université de Franche-Comté, Besançon, France
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17
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Bartolotta TV, Vernuccio F, Taibbi A, Lagalla R. Contrast-Enhanced Ultrasound in Focal Liver Lesions: Where Do We Stand? Semin Ultrasound CT MR 2016; 37:573-586. [PMID: 27986175 DOI: 10.1053/j.sult.2016.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography, and it is being increasingly used for the evaluation of focal liver lesions (FLLs). Currently, CEUS is included as a part of the suggested diagnostic workup of FLLs, resulting in a better patient management and delivering cost-effective therapy. After a brief technical note, contrast-enhancement patterns of different types of benign and malignant FLLs, along with hepatic pseudolesions, are described and discussed based on our experience and literature data. At the same time, the most recent concepts and the use of CEUS in different clinical settings are presented.
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Affiliation(s)
| | - Federica Vernuccio
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Adele Taibbi
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Roberto Lagalla
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
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Kratzer W, Gruener B, Kaltenbach TEM, Ansari-Bitzenberger S, Kern P, Fuchs M, Mason RA, Barth TFE, Haenle MM, Hillenbrand A, Oeztuerk S, Graeter T. Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: Echinococcosis multilocularis Ulm classification-ultrasound. World J Gastroenterol 2015; 21:12392-12402. [PMID: 26604646 PMCID: PMC4649122 DOI: 10.3748/wjg.v21.i43.12392] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/19/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis (AE).
METHODS: Clinical data and ultrasonography (US) findings of 185 patients (100 males; 85 females; mean age at diagnosis: 51.4 ± 17.6 years; mean age at time of US examination: 58.7 ± 18.2 years) were retrospectively reviewed with respect to the US morphology of hepatic AE lesions. The sonomorphological findings were grouped according to a five-part classification scheme.
RESULTS: Application of the new classification resulted in the following distribution of sonomorphological patterns among the patients examined: hailstorm (54.1%); pseudocystic (13.5%); ossification (13.0%); hemangioma-like (8.1%); and metastasis-like (6.5%). Only 4.9% of lesions could not be assigned to a sonomorphological pattern.
CONCLUSION: The sonomorphological classification proposed in the present study facilitates the diagnosis, interpretation and comparison of hepatic alveolar echinococcosis in routine practice and in the context of scientific studies.
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Li H, Song T, Qin Y, Liu W, Li X, Shao Y, Wen H. Efficiency of liposomal albendazole for the treatment of the patients with complex alveolar echinococcosis: a comparative analysis of CEUS, CT, and PET/CT. Parasitol Res 2015; 114:4175-80. [DOI: 10.1007/s00436-015-4649-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/23/2015] [Indexed: 12/28/2022]
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Song T, Li H, Yang L, Lei Y, Yao L, Wen H. Expression of Hypoxia-Inducible Factor-1α in the Infiltrative Belt Surrounding Hepatic Alveolar Echinococcosis in Rats. J Parasitol 2015; 101:369-73. [DOI: 10.1645/14-685.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kaltenbach TEM, Graeter T, Mason RA, Oeztuerk S, Haenle MM, Gruener B, Gottstein M, Kratzer W. Determination of vitality of liver lesions by alveolar echinococcosis. Nuklearmedizin 2015; 54:43-49. [DOI: 10.3413/nukmed-0670-14-05] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
SummaryObjective of our study is qualitative and quantitative comparison of contrast enhanced ultrasound (CEUS) and 18F-FDG PETCT in monitoring hepatic alveolar echinococcosis (HAE). Parasitic liver lesions were examined regarding number, size, morphology, vascularization and metabolic activity. Patients, methods: 36 patients with medicallytreated HAE were included in this prospective clinical study. Abdominal ultrasound and CEUS were carried out using ultrasound contrast amplifier SonoVue®. As part of monitoring, patients were examined by 18F-FDG-PET-CT. Quantitative analysis of CEUS was performed using the Software Vue- Box™ Quantification Toolbox. Maximum contrast enhancement in lesions peak enhancement (PE) was used as parameter. For quantification of 18F-FDG PET-CT, maximum Standardized Uptake Value (SUVmax) of lesions was specified and statistically compared with PE. Results: 18F-FDG uptake in parasitic liver lesions was diagnosed by 18F-FDG PET-CT in 32 of 36 patients. Vascularization of liver lesions was detected by CEUS in 22 of 32 FDG-positive patients with sensitivity of 69% and specificity of 100%. Mean maximum diameter of lesions was 69.5mm in CEUS and 63.7mm in B-scan ultrasound (p < 0.0001). No significant correlation was found between SUVmax and PE (p = 0.8879). Conclusion: In comparison to FDG PET-CT, the gold standard for detecting viable lesions by depicting metabolism, CEUS detects viable lesions with high specificity and moderate sensitivity by showing vascularization. CEUS must be regarded as an important tool in monitoring HAE. Dimensions of parasitic lesions are displayed more precisely through CEUS than in B-scan. With currently available methods, CEUS quantification has no benefit in monitoring HAE lesions in daily clinical practice.
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Liu W, Delabrousse É, Blagosklonov O, Wang J, Zeng H, Jiang Y, Wang J, Qin Y, Vuitton DA, Wen H. Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones. ACTA ACUST UNITED AC 2014; 21:74. [PMID: 25531446 PMCID: PMC4273719 DOI: 10.1051/parasite/2014072] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/11/2014] [Indexed: 12/12/2022]
Abstract
Hepatic Alveolar Echinococcosis (HAE), caused by larvae of Echinococcus multilocularis, is a rare but potentially lethal parasitic disease. The first diagnostic suspicion is usually based on hepatic ultrasound exam performed because of abdominal symptoms or in the context of a general checkup; HAE diagnosis may thus also be an incidental finding on imaging. The next step should be Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). They play an important role in the initial assessment of the disease; with chest and brain imaging, they are necessary to assess the PNM stage (parasite lesion, neighboring organ invasion, metastases) of a patient with AE. Performed at least yearly, they also represent key exams for long-term follow-up after therapeutic interventions. Familiarity of radiologists with HAE imaging findings, especially in the endemic regions, will enable earlier diagnosis and more effective treatment. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is currently considered to be the only noninvasive, albeit indirect, tool for the detection of metabolic activity in AE. Delayed acquisition of images (3 hrs after FDG injection) enhances its sensitivity for the assessment of lesion metabolism and its reliability for the continuation/withdrawal of anti-parasite treatment. However, sophisticated equipment and high cost widely limit PET/CT use for routine evaluation. Preliminary studies show that new techniques, such as contrast-enhanced ultrasound (US), Dual Energy CT or Spectral CT, and Diffusion-Weighted MRI, might also be useful in detecting the blood supply and metabolism of lesions. However, they cannot be recommended before further evaluation of their reliability in a larger number of patients with a variety of locations and stages of AE lesions.
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Affiliation(s)
- Wenya Liu
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Éric Delabrousse
- Department of Visceral Radiology, University Hospital Jean Minjoz, 25030 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France
| | - Oleg Blagosklonov
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France - Department of Nuclear Medicine, University Hospital Jean Minjoz, 25030 Besançon, France
| | - Jing Wang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Hongchun Zeng
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China
| | - Yi Jiang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Jian Wang
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Yongde Qin
- Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China
| | - Dominique Angèle Vuitton
- WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France
| | - Hao Wen
- Department of Hepatic surgery, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China
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Kaltenbach TEM, Gruener B, Akinli AS, Kratzer W, Oeztuerk S, Mason RA, Haenle MM, Graeter T. Acoustic structure quantification (ASQ): a new tool in sonographic examination of liver lesions in hepatic alveolar echinococcosis. J Med Ultrason (2001) 2014; 41:445-53. [PMID: 27278025 DOI: 10.1007/s10396-014-0540-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/24/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE Qualitative and quantitative acoustic structure quantification (ASQ) is a new, noninvasive sonographic imaging method based on B-mode. This prospective clinical pilot study aims to answer the question whether delineation and measurement of liver lesions in hepatic alveolar echinococcosis (HAE) can be improved by ASQ. Furthermore, this is the first pilot study to explore how ASQ parameters in HAE lesions develop. METHODS A total of 24 patients (male = 13/female = 11, mean age = 52 years (16-85), mean disease duration = 68 months (1-334)) with HAE were examined with ASQ using a Toshiba Aplio 500 unit. ASQ parameters were measured in HAE liver lesions and in adjacent non-tumor parenchyma. Quantitative analysis was performed offline using ASQ quantification software. RESULTS Subjectively parasitic tumors in HAE appear more prominent in color-coded ASQ imaging, but the size of lesions measured in ASQ mode does not differ from size measurements in B-mode. Median focal disturbance ratio (FD ratio) in lesions was 3 (0.1-3), compared with 0.5 (0.1-1.8) in surrounding liver parenchyma (p < 0.0001). Statistical comparison of other ASQ parameters (mode, average, standard deviation) shows results that are similarly significant with p values between p < 0.0001 and p < 0.0018. CONCLUSION ASQ is a promising sonographic method for examination and quantification of structural changes of liver parenchyma in HAE lesions.
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Affiliation(s)
- Tanja Eva-Maria Kaltenbach
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Beate Gruener
- Section of Infectious Diseases and Clinical Immunology, Comprehensive Infectious Diseases Center (CIDC) Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Atilla Serif Akinli
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Suemeyra Oeztuerk
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Richard Andrew Mason
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH, 44106, USA
| | - Mark Martin Haenle
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Tilmann Graeter
- Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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24
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Zeng H, Wang J, Xie W, Liu W, Wen H. Assessment of early hepatic echinococcus multilocularis infection in rats with real-time contrast-enhanced ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:1982-1988. [PMID: 22929653 DOI: 10.1016/j.ultrasmedbio.2012.07.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/08/2012] [Accepted: 07/13/2012] [Indexed: 06/01/2023]
Abstract
The aim of this study was to demonstrate characteristic imaging and accurate evaluation of blood perfusion in early stage of hepatic alveolar echinococcosis (HAE) by contrast-enhanced ultrasonography (CEUS). The early stage of experimentally induced secondary HAE in 45 rats was studied. Thirty-six HAE lesions in 33 rats, confirmed by pathologic examination, were examined by ultrasound (US), color Doppler flow imaging (CDFI) and then CEUS. Thirty-three lesions were found in 30 rats by US, and 30 lesions were detected in 27 rats by CEUS. The sensitivity of US and CEUS was 92% (95% CI 76%-98%) and 82% (95% CI 65%-93%), respectively. US imaging characteristics were categorized into four types: hyperechoic spot (type 1, 45.5%, 15/33), granular hyperechoic spots (type 2, 12.1%, 4/33), hyperechoic lesion (type 3, 30.3%, 10/33) and mixed pattern (type 4, 12.1%, 4/33). CDFI failed to detect blood flow signals in any lesions. CEUS results for 30 lesions showed ring enhancement in the peripheral area during the arterial phase and no filling effect in either the portal or the delayed phase (46.7%, 14/30); ring enhancement combined with central septa enhancement during the arterial phase and portal venous phase (46.7, 14/30), and no enhancement (6.6%, 2/30). The enhanced area, confirmed by pathologic examination, was an inflammatory reaction belt surrounding the lesion. The results of this study suggest that US, with high sensitivity, can be used as a screening method for early HAE lesions in the animal model, while CEUS can be used for displaying the peripheral blood perfusion and vesicle structure.
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Affiliation(s)
- Hongchun Zeng
- Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, P.R. China
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25
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Liu Y, Ren W, Liu C, Huang K, Feng Y, Wang X, Tong Y. Contrast-enhanced ultrasonography of the rabbit VX2 tumor model: Analysis of vascular pathology. Oncol Lett 2012. [PMID: 23205083 DOI: 10.3892/ol.2012.819] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The accuracy of diagnosing tumors may be improved significantly by detecting the microvascular distribution. Indeed, contrast-enhanced ultrasonography (CEUS) has shown a distinct advantage in detecting microvasculature. This study aimed to determine the angiogenic characteristics of VX2 tumors in rabbits using CEUS. A total of 17 rabbits were injected with 0.5 ml VX2 cell suspension into the muscles of both hind legs to prepare the VX2 tumor models. At 14, 21, 28 and 35 days after tumor inoculation, CEUS was performed on the rabbits with 0.3 ml SonoVue following a local anesthesia. The pathological findings of the tumors were compared. A total of 12 rabbits survived after being inoculated with the tumor cells and developed a total of 38 tumors. The size of the tumors ranged from 1.12 to 10.85 cm. Using CEUS, all tumors demonstrated rim enhancement with some unenhanced regions. Enhancement began from the peripheral region and quickly showed internal reticular vessels. Regardless of the tumor size or the presence of necrosis, no complete enhancement of the tumors was observed. On microscopic examination, VX2 tumor cells were detected in striated muscles, immature blood capillaries and fibrosis tissues scattered in tumor nests. Immunohistochemical examination revealed that CD34+ cells appeared mainly in the muscles adjacent to vessels. In conclusion, CEUS may be an efficient method to evaluate angiogenesis and blood perfusion in VX2 tumors.
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Affiliation(s)
- Yanjun Liu
- Department of Ultrasound, First Affiliated Hospital, China Medical University, Shenyang 110001
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