Fatal Liver and Lung Alveolar Echinococcosis with Newly Developed Neurologic Symptoms due to the Brain Involvement

The value of nomogram based on MRI functional imaging in differentiating cerebral alveolar echinococcosis from brain metastases

OBJECTIVE

This study aims to evaluate the effectiveness of a nomogram model constructed using Diffusion Kurtosis Imaging (DKI) and 3D Arterial Spin Labeling (3D-ASL) functional imaging techniques in distinguishing between cerebral alveolar echinococcosis (CAE) and brain metastases (BM).

METHODS

Prospectively collected were 24 cases (86 lesions) of patients diagnosed with CAE and 16 cases (69 lesions) of patients diagnosed with BM at the affiliated hospital of Qinghai University from 2018 to 2023, confirmed either pathologically or through comprehensive diagnosis. Both patient groups underwent DKI and 3D-ASL scanning. DKI parameters (Kmean, Dmean, FA, ADC) and cerebral blood flow (CBF) were analyzed for the parenchymal area, edema area, and symmetrical normal brain tissue area in both groups. There were 155 lesions in total in the two groups of patients. We used SPSS to randomly select 70% as the training set (108 lesions) and the remaining 30% as the test set (47 lesions) and performed a difference analysis between the two groups. The independent factors distinguishing CAE from BM were identified using univariate and multivariate logistic regression analyses. Based on these factors, a diagnostic model was constructed and expressed as a nomogram.

RESULT

Univariate and multivariate logistic regression analyses identified nDmean1 and nCBF1 in the lesion parenchyma area, as well as nKmean2 and nDmean2 in the edema area, as independent factors for distinguishing CAE from BM. The model's performance, measured by the area under the ROC curve (AUC), had values of 0.942 and 0.989 for the training and test sets, respectively. Calibration curves demonstrated that the predicted probabilities were highly consistent with the actual values, and DCA confirmed the model's high clinical utility.

CONCLUSION

The nomogram model, which incorporates DKI and 3D-ASL functional imaging, effectively distinguishes CAE from BM. It offers an intuitive, accurate, and non-invasive method for differentiation, thus providing valuable guidance for subsequent clinical decisions.

The value of nomogram analysis in prediction of cerebral spread of hepatic alveolar echinococcosis

BACKGROUND

The prognosis after brain metastasis of alveolar echinococcosis is inferior, but there is currently no effective method to predict brain metastasis.

PURPOSE

To explore the value of a nomogram constructed based on a CT plain scan and enhanced imaging features combined with clinical indicators in predicting brain metastasis of hepatic alveolar echinococcosis (HAE).

MATERIALS AND METHODS

The imaging characteristics and clinical indicators of 116 patients diagnosed with HAE in the Affiliated Hospital of Qinghai University from 2015 to 2022 were retrospectively collected. The data were randomly divided into a training set and a validation set according to 7:3, and the difference between the two groups was analyzed. Binary logistic regression analysis was used to obtain independent predictors of brain metastasis in HAE, and a prediction model was constructed based on this and expressed in the form of a nomogram. Receiver operating characteristic (ROC) curve and calibration curve (CRC) were used to evaluate model performance, and decision curve analysis (DCA) was used to assess the clinical value of the predictive model.

RESULT

A total of 116 HAE patients were included (average age 38.07±15.09 years old, 54 males and 62 females, 81 patients (70 %) in the training set, and 35 patients (30 %) in the validation set). There was no statistically significant difference between CT plain scan and enhanced imaging features combined with clinical indicators between the training set and the validation set (p > 0.05). After statistical analysis, it was found that whether there is invasion of the inferior vena cava, whether there is invasion of the hepatic artery, and whether there is metastasis to other organs are independent predictors of brain metastasis in HAE. A prediction model was built based on these three variables. The area under the ROC curve (AUC), cutoff value, sensitivity, and specificity of the training set and validation set were 0.922 and 0.886, 0.6934 and 0.6643, 75.00 and 84.62, 94.34 and 81.82, respectively. CRC shows good consistency between the predicted probability and the actual value of the sample. DCA showed that the clinical value of the model was high.

CONCLUSION

The nomogram constructed based on imaging features combined with clinical indicators can effectively predict whether HAE will develop brain metastasis, which is helpful for clinicians to quickly screen out high-risk patients with HAE developing brain metastases, evaluate patient prognosis, and is more conducive to the realization of individualized and precise medical decisions.

Intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis: a multicenter cohort study

BACKGROUND

The main endemic areas of alveolar echinococcosis (AE) are in central Europe and western China. The infiltration of intrahepatic vascular and bile ducts as well as extrahepatic disease can lead to complications and may increase morbidity in AE.

PURPOSE

To evaluate the vascular/biliary involvement of hepatic alveolar echinococcosis (HAE) and distant extrahepatic disease at each of four locations in Germany, France, and China.

MATERIAL AND METHODS

Contrast-enhanced abdominal magnetic resonance imaging (MRI) scans of patients with HAE, 200 in total, were evaluated by five examiners. AE liver lesions were classified according to Kodama's classification. Furthermore, distant extrahepatic manifestations were documented with additionally performed imaging modalities. Vascular/biliary involvement of hepatic manifestations as well as the presence of extrahepatic manifestations were correlated with the respective Kodama type of the liver lesion.

RESULTS

Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (12/100 vs. 3/100; Fisher's exact test: P=0.0286). A significant relationship exists between presence of distant extrahepatic disease manifestation and size of the AE liver lesion (132.53 ± 48.65 vs. 92.49 ± 50.06; P = 0.0030). Vascular/biliary involvement is significantly more frequent in China than in Europe (86/100 vs. 65/100; χ² = 11.92; P = 0.0006). Vascular/biliary involvement depends on lesion size (111.10 ± 47.44 vs. 47.36 ± 24.36; P<0.0001). Different types of AE liver lesions are associated with differences in vascular/biliary involvement and extrahepatic manifestations.

CONCLUSION

Vascular/biliary involvement and presence of distant extrahepatic manifestations depend on size of the HAE lesions and are more frequently detected in China. Different MRI morphological patterns influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations.

A Case of Human Hepatic Alveolar Echinococcosis Accompanied by Lung and Brain Metastases

Alveolar echinococcosis (AE) is considered as a fatal zoonosis caused by the larvae of Echinococcus multilocularis. The lungs and brain are the most common metastatic organs. We report a human case of hepatic alveolar echinococcosis accompanied by lung and brain metastasis. In particular, the patient had a history of tuberculosis and the lung lesions were easily misdiagnosed as lung abscesses. The lesions of liver and lung underwent radical resection and confirmed as alveolar echinococcosis by pathological examination. The patient had no surgical complications after operation and was discharged after symptomatic treatment. Unfortunately, the patient later developed multiple intracerebral AE metastases. We required the patient to take albendazole orally for life and follow up.

Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis

BACKGROUND

The main endemic areas of alveolar echinococcosis (AE) are in Central Europe and Western China. Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE.

AIM

To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim.

METHODS

Consecutively, five experienced examiners evaluated contrast-enhanced abdominal computed tomography (CT) scans for 200 patients with hepatic AE of each of four locations (n = 50) in Germany, France and China. Therefore, we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center, performed because of hepatic AE from September 21, 2007 to March 21, 2018. AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT (EMUC-CT). Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging. Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion. Statistical analysis was performed using SAS Version 9.4 (SAS Institute Inc., Cary, NC, United States).

RESULTS

Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (P = 0.0091). A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size (P = 0.0075). Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe (P < 0.0001), and vascular/biliary involvement depended on lesion size. Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations: Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88% of type IV liver lesions to 100% among type III lesions. Type IV differed significantly in these associations from types I, II, and III (P < 0.0001). With respect to extrahepatic disease, the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease. In contrast, distant extrahepatic manifestations in types I–III were found to varying degrees, with a maximum of 22% for type III.

CONCLUSION

Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations. There are intercontinental differences regarding the characteristics of AE manifestation.

Human Cystic Echinococcosis in Different Geographical Zones of Iran: An Observational Study during 1995-2014

BACKGROUND

Cystic Echinococcosis (CE) is a serious zoonotic parasitic disease in Iran. This study aimed to show the trend of the confirmed disease from 1995 to 2014 and to describe some of epidemiological aspects of the disease in Iran.

METHODS

This retrospective study has been designed based on data collected from 8518 cases of CE among various geographical locations of Iran.

RESULTS

The average annual number of human cases of CE was 274.8. Among 31 provinces of Iran, Razavi Khorasan from northeast part of Iran was the highest human CE infected province with the 1801 cases and Hormozgan Province in south part of the country showed the lowest the disease with the only one case of CE in 2009. Liver and lungs with the infection rate of 61% and 20%, respectively are the most infected organs, 53% of patients had one cyst in the bodies and the number of cysts in 8% of cases was more than 3 cysts. Altogether, 41% of CE cases were treated by surgery, 11% with chemotherapy and 48 % with mixed surgery and chemotherapy.

CONCLUSION

Human CE is a major health problem in Iran and it is necessary to establish basic control programs. It is crucial to setting up standard diagnostic methods for early diagnosis, effective treatment, plan educational schedule for different social levels and control the disease in both definitive and intermediate hosts.

Serological validation of an alveolar echinococcosis rat model with a single hepatic lesion

Serology is important for the diagnosis and follow-up of human alveolar echinococcosis (AE). However, patient conditions are highly variable among those with AE, and antibody responses in serological follow-up have not been well-defined. We recently described a new AE rat model established by implantation of small AE tissue into a single arbitrary location in the liver; no metastasis and dissemination were observed. In the present study, we examined the serological characteristics in our rat model before and after surgical treatment. The results showed that antibody responses against crude antigens were increased at one month after transplantation and similar to those of other model animals. For the antigen Em18, antibody responses were slower in our rat model than in other animal models. After surgical resection, changes in antibody responses against Em18 were similar to those observed in human patients with AE. Because of the slow growth of lesions, establishment of a single hepatic lesion and patterns of antibody responses, our rat model may be useful for clarifying follow-up serodiagnoses in human AE and determining the mechanisms of multi-organ involvement by primary infection with oncospheres rather than metastasis.