Alveolar Liver Echinococcosis: A Comparative Study of Three Imaging Techniques

Reuter, Stefan; Nüssle, K; Kolokythas, Orpheus; Haug, U.; Rieber, A.; Kern, Peter; Kratzer, Wolfgang

doi:10.1007/s15010-001-1081-2

Cited by 112 publications

(84 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several cyst stages in CE have pathognomonic radiological signs [21]. In AE, specific radiological features, such as the lack of perilesional enhancement as compared to neoplasias [62], will restrict differential diagnoses and therefore influence pre-test and subsequently PTPs in a positive or negative way. For example, if the differentiation of CE from other cystic liver lesions were possible with a probability of 75%, positive PTPs for CE would increase to [95% after serological diagnosis with EgPI as compared to 87% when only prevalence is used.…”

Section: Discussionmentioning

confidence: 99%

Serological diagnosis of echinococcosis: the diagnostic potential of native antigens

et al. 2011

View full text Add to dashboard Cite

PURPOSE: Human alveolar (AE) and cystic echinococcosis (CE) caused by the metacestode stages of Echinococcus multilocularis and E. granulosus, respectively, lack pathognomonic clinical signs. Diagnosis therefore relies on the results of imaging and serological studies. The primary goal of this study was to evaluate the efficacy of several easy-to-produce crude or partially purified E. granulosus and E. multilocularis metacestode-derived antigens as tools for the serological diagnosis and differential diagnosis of patients suspicious for AE or CE. METHODS: The sera of 51 treatment-naïve AE and 32 CE patients, 98 Swiss blood donors and 38 patients who were initially suspicious for echinococcosis but suffering from various other liver diseases (e.g., liver neoplasia, etc.) were analysed. RESULTS: According to the results of enzyme-linked immunosorbent assays (ELISA), metacestode-derived antigens of E. granulosus had sensitivities varying from 81 to 97% and >99.9% for the diagnosis of CE and AE, respectively. Antigens derived from E. multilocularis metacestodes had sensitivities ranging from 84 to 91% and >99.9% for the diagnosis of CE and AE, respectively. Specificities ranged from 92 to >99.9%. Post-test probabilities for the differential diagnosis of AE from liver neoplasias, CE from cystic liver lesions, and screening for AE in Switzerland were around 95, 86 and 2.2%, respectively. Cross-reactions with antibodies in sera of patients with other parasitic affections (fasciolosis, schistosomosis, amebosis, cysticercosis, and filarioses) did occur at variable frequencies, but could be eliminated through the use of confirmatory testing. CONCLUSIONS: Different metacestode-derived antigens of E. granulosus and E. multilocularis are valuable, widely accessible, and cost-efficient tools for the serological diagnosis of echinococcosis. However, confirmatory testing is necessary, due to the lack of species specificity and the occurrence of cross-reactions to other helminthic diseases. Abstract Purpose Human alveolar (AE) and cystic echinococcosis (CE) caused by the metacestode stages of Echinococcus multilocularis and E. granulosus, respectively, lack pathognomonic clinical signs. Diagnosis therefore relies on the results of imaging and serological studies. The primary goal of this study was to evaluate the efficacy of several easy-to-produce crude or partially purified E. granulosus and E. multilocularis metacestode-derived antigens as tools for the serological diagnosis and differential diagnosis of patients suspicious for AE or CE. Methods The sera of 51 treatment-naïve AE and 32 CE patients, 98 Swiss blood donors and 38 patients who were initially suspicious for echinococcosis but suffering from various other liver diseases (e.g., liver neoplasia, etc.) were analysed. Results According to the results of enzyme-linked immunosorbent assays (ELISA), metacestode-derived antigens of E. granulosus had sensitivities varying from 81 to 97% and [99.9% for the diagnosis of CE and AE, respectively. Antigens derived from...

show abstract

Section: Discussionmentioning

confidence: 99%

Serological diagnosis of echinococcosis: the diagnostic potential of native antigens

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Obstruction of the inferior vena cava or the portal venous system may be evident and may be more easily appreciated on MRI scan. Lung, brain and bone lesions may also be detected in a similar manner [76].…”

Section: Imagingmentioning

confidence: 91%

Pulmonary echinococcosis

Morar¹,

Feldman²

2003

Eur Respir J

270

317

View full text Add to dashboard Cite

“…Conventional imaging techniques such as ultrasound (US), computerized tomography (CT), and magnetic -resonance imaging strongly rely on morphological changes and are unable to demonstrate functional signs of metabolism (e.g., infiltration of inflammatory cells, parasite activity). 7 With these techniques, disease progression can only be evaluated retrospectively by changes in size of parasitic lesions. However, in nonprogressive cases under continuing benzimidazole treatment, one cannot differentiate between parasitostatic and parasitocidal effects, and we lack reliable means of deciding on whom to discontinue from chemotherapy.…”

mentioning

confidence: 99%

Structured treatment interruption in patients with alveolar echinococcosis

Reuter¹,

Buck²,

Manfras³

et al. 2004

Hepatology

155

125

View full text Add to dashboard Cite

In human alveolar echinococcosis (AE), benzimidazoles are given throughout life because they are only parasitostatic. It has been a longstanding goal to limit treatment, and recent reports suggest that, in selected cases, benzimidazoles may be parasitocidal. Previously, we showed that positron -emission tomography (PET) using [ 18 F]fluoro-deoxyglucose discriminates active from inactive lesions in AE. We have now performed a 3-year prospective study in 23 patients and conducted a structured treatment interruption in those without signs of PET activity. Disease progression was further assessed by ultrasound, computerized tomography, laboratory parameters, and clinical examination.We found PET-negative lesions in 15 of 23 patients and benzimidazoles were discontinued in these patients. After 18 months, patients were reevaluated, and, of the 15 initially PET-negative patients, 8 showed either new activity on PET (n ‫؍‬ 6) or signs of clinical progression (n ‫؍‬ 2). Reinitiation of benzimidazoles halted parasite growth again. No further progression was detected after 36 months. PET had a sensitivity of 91% for the detection of active lesions. In conclusion, despite successful suppression of metabolic activity, in most cases benzimidazoles do not kill the parasite. PET is a reliable tool for assessing metabolic activity and for timely detection of relapses. Neither duration of treatment, kind of treatment, lesion size, calcifications, or regressive changes reliably indicate parasite death. We discourage the discontinuation of benzimidazoles in inoperable AE even after many years of treatment. However, patients with a poor compliance of benzimidazole intake or patients suffering from side effects to benzimidazoles might be assessed for PET negativity. If permanent discontinuation of benzimidazoles is attempted, the course of disease should be followed by PET. (HEPATOLOGY 2004;39: 509 -517.)

show abstract

Alveolar Liver Echinococcosis: A Comparative Study of Three Imaging Techniques

Cited by 112 publications

References 20 publications

Serological diagnosis of echinococcosis: the diagnostic potential of native antigens

Serological diagnosis of echinococcosis: the diagnostic potential of native antigens

Pulmonary echinococcosis

Structured treatment interruption in patients with alveolar echinococcosis

Contact Info

Product

Resources

About