Hepatic Alveolar Echinococcosis

Bresson‐Hadni, Solange; Chappuis, François

doi:10.1055/s-0041-1730925

Cited by 32 publications

(27 citation statements)

References 121 publications

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“…Once diagnosed, every patient mandatorily receives a parasitostatic pharmacotherapy with benzimidazole derivatives (BMZ), preferably albendazole. If possible, complete surgical removal of the parasitic lesions or metacestode tissue plus temporary adjuvant pharmacotherapy is the treatment of choice [8,10], while lifelong parasitostatic pharmacotherapy with BMZ alone offers an alternative if surgery is infeasible [11,12]. Therapeutic success is again assessed using imaging and laboratory procedures.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Serological Markers in Alveolar Echinococcosis Emphasizing the Correlation of PET-CTI Tracer Uptake with RecEm18 and Echinococcus-Specific IgG

et al. 2022

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Human alveolar echinococcosis (AE), which is caused by the cestode Echinococcus (E.) multilocularis, is an epidemiologically relevant issue in modern medicine and still poses a diagnostic and therapeutic challenge. Since diagnosis mainly relies on imaging procedures and serological testing, we retrospectively and comparatively analyzed the performance of an Echinococcus IgG screening ELISA, whole serum IgE, and two specific confirmatory ELISA platforms using the defined E. multilocularis antigens Em2-Em18 (Em2+) and recombinant Em18 (recEm18). With special emphasis on the clinical usefulness of recEm18, we correlated the laboratory results with clinical characteristics and imaging findings in a large and well-characterized cohort of N = 124 AE patients, who were followed over several years after either surgical plus subsequent pharmacological treatment or pharmacotherapy alone. All patients had routinely received PET-CTI every two years. Our data reveal strong correlations for both Echinococcus IgG and recEm18 with tracer uptake in PET-CTI and parasitic lesion size and number, suggesting additional clinical usefulness of recEm18 for certain constellations only, while IgG and Em2+ still appear reasonable and sensitive screening methods for initial diagnosis of AE. With this study, we aim to contribute to further optimizing medical care of AE patients. For instance, it might be reasonable to consider the replacement of some PET-CTI follow-ups by imaging procedures with less radiation exposure or serological means alone. Further studies that clarify the correlation of serological markers with ultrasound criteria might be particularly useful, and further retrospective as well as prospective investigations are justified in this context.

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Section: Introductionmentioning

confidence: 99%

Evaluation of Serological Markers in Alveolar Echinococcosis Emphasizing the Correlation of PET-CTI Tracer Uptake with RecEm18 and Echinococcus-Specific IgG

et al. 2022

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“…Given the infectious nature of the disease and the high risk of metastatic disease progression on immunosuppression, clinicians are reluctant to list these patients for transplantation early in the course of disease. Bresson-Hadni et al reported that the number of patients that underwent LT for AE is decreasing due to the better understanding of medical, surgical and interventional treatment [47].…”

Section: Discussionmentioning

confidence: 99%

Alveolar Echinococcosis—A Challenging Task for the Hepatobiliary Surgeon

Strohaeker

Sulyok²,

Koenigsrainer

et al. 2021

Pathogens

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(1) Background: Alveolar echinococcosis (AE) is an ultimately fatal disease, whose only curative treatment is surgery. Due to its late presentation extended liver resections are often necessary. The true benefit of extensive surgery has yet to be established; (2) Methods: We present a single center experience of 33 cases of Echinococcus multilocularis that have been treated at a high-volume hepatobiliary surgery center between 2004 and 2021. (3) Results: Of the 33 patients 24 patients underwent major liver resection (73%). In addition to the liver resection patients frequently underwent complex extrahepatic procedures such as lymphadenectomy (n = 21, 61%), vascular resections and reconstructions (n = 9, 27%) or resections and reconstruction of the extrahepatic bile duct (n = 11, 33%). Seven patients suffered from ≥ grade III complications (21%). Complete resection was achieved in 17 patients. Fourteen patients had R1 resections and two had macroscopic parasitic remnant (R2). Progressive disease was reported in three patients (The two R2 patients and one R1 resected patient). At a median follow-up of 54 months no mortality has occurred in our cohort; (4) Conclusions: Liver resection remains the gold standard for AE. Even in extensive disease the combination of complex resection and perioperative benzimidazoles can achieve favorable long-term outcomes.

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“…The PNM categorization system denotes the presence of a parasite mass in the hepatic artery (P), the involvement of surrounding organs (N), and the involvement of distant sites (M). The goal of the PNM classification system is to improve the quality of service and to allow for consistent outcome evaluation across healthcare institutions [5]. An important role for radiologists is to ensure timely referral to specialists and imaging follow-up; but because AE imaging features are so variable, initial misdiagnosis is common, especially in nonendemic areas.…”

Section: Introductionmentioning

confidence: 99%

Imaging Aspects of Hepatic Alveolar Echinococcosis: Retrospective Findings of a Surgical Center in Turkey

et al. 2022

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Radiologists should be aware of the findings of alveolar echinococcosis (AE) due to the diagnostic and management value of imaging. We are attempting to define the most common diagnostic imaging findings of liver AE, along with the prevalence and distribution of those findings. The patients’ US, CT, and MRI images were reviewed retrospectively. CT images were acquired with and without the administration of contrast medium. The MRI protocol includes T2-weighted images (WI), diffusion (WI), apparent diffusion coefficient (ADC) maps, and pre- and post-contrast T1WIs. The current study included 61 patients. The mean age of the population was 58.2 ± 9.6 years According to Kratzer’s categorization (US), 139 lesions (73.1%) were categorized as hailstorm. According to Graeter’s classification (CT), 139 (73.1%) lesions were type 1-diffuse infiltrating. The most frequent types were Kodama type 2 and 3 lesions (MRI) (42.6% and 48.7%, accordingly). P2N0M0 was the most frequent subtype. The current study defines the major, characteristic imaging findings of liver AE using US, CT, and MRI. Since US, CT, and MRI have all been utilized to diagnose AE, we believe that a multi-modality classification system is needed. The study’s findings may aid radiologists in accurately and timely diagnosing liver AE.

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Hepatic Alveolar Echinococcosis

Cited by 32 publications

References 121 publications

Evaluation of Serological Markers in Alveolar Echinococcosis Emphasizing the Correlation of PET-CTI Tracer Uptake with RecEm18 and Echinococcus-Specific IgG

Evaluation of Serological Markers in Alveolar Echinococcosis Emphasizing the Correlation of PET-CTI Tracer Uptake with RecEm18 and Echinococcus-Specific IgG

Alveolar Echinococcosis—A Challenging Task for the Hepatobiliary Surgeon

Imaging Aspects of Hepatic Alveolar Echinococcosis: Retrospective Findings of a Surgical Center in Turkey

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