Hepatic alveolar echinococcosis: correlative US and CT study.

Didier, Dominique; Weiler, S; Rohmer, P; Lassègue, A; Deschamps, J. P.; Vuitton, Dominique-Angèle; Miguet, Jean-Philippe; Weill, F

doi:10.1148/radiology.154.1.3880602

Cited by 125 publications

(51 citation statements)

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“…Calcifications are considered pathognomonic for AE lesions. 24,25 Earlier reports suggested that calcifications might reflect lack of parasitic activity. 6 From extensive calcifications seen with CT, it was even concluded that long-term benzimidazoles might be parasitocidal.…”

Section: Discussionmentioning

confidence: 99%

Structured treatment interruption in patients with alveolar echinococcosis

Reuter¹,

Buck²,

Manfras³

et al. 2004

Hepatology

155

125

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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.)

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Section: Discussionmentioning

confidence: 99%

Structured treatment interruption in patients with alveolar echinococcosis

Reuter¹,

Buck²,

Manfras³

et al. 2004

Hepatology

155

125

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“…ERCP and hepatic venography may be needed to find the site and extent of bile duct and hepatic vein disease, and for possible dilation and stenting. 56,57 Treatment Treatment options include radical resection of the involved liver segments or other affected organs, long-term chemotherapy and liver transplantation. Radical liver resection is considered in patients with localized liver disease without involvement of major blood vessels and distant metastasis.…”

Section: Imagingmentioning

confidence: 99%

Hydatid Disease: Current Status and Recent Advances

Khuroo

2002

Ann Saudi Med

101

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“…Changes in CE lesions during chemotherapy have been reported 12 ; however, few similar studies have been reported in AEL. 13,14 We used a tentative criteria of response in which volume changes of lesions were measured by CT scan. Lesions with unchanged volumes were classified as no success in our study because some cases of spontaneous parasite death have included lesions that persisted unchanged over years.…”

Section: Fig 1 Changes In Lesion Volumes After Albendazole Therapymentioning

confidence: 99%

Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery

et al. 1997

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palliative operations such as marsupialization with biliary drainage, Patients with alveolar echinococcosis of the liverand laparotomy were performed in 14, 5, and 1 cases, respectively.(AEL) can be cured by complete excision of the lesions;Mebendazole had been given before albendazole therapy in 9 cases. however, it is not always completely resectable in ad-Eight patients had lung metastasis, and 2 had lymph node metastavanced cases. Recently, benzimidazole-type drugs have sis. The staging system proposed by Nakajima et al. 10 was used.been reported to be effective in nonresectable AEL. One Five groups (I, II, IIIa, IIIb, and IV) are obtained according to three hundred fifty-two patients with AEL have been surgi-principal degrees of anatomic extent: apparent localization of the cally treated in our institution since 1937. Our clinical site of origin (occupied segments); evidence of regional spread to the adjacent tissue or organ, usually in the form of direct invasion; and trial with albendazole, one of the benzimidazole carba- A IIIb indicates, in addition to involvement of one to three segments, favorable response to albendazole, such as decreases in regional tissue or organ invasion and/or distant metastasis, but all the size of the lesions, changes in cyst morphology, and lesions should be resectable. Stage IV indicates intrahepatic lesions amelioration in clinical symptoms or signs, was achieved occupied in four segments and/or regional invasion and/or distant in 11 (55%) cases. These favorable responses were also metastasis of which every lesion is nonresectable (i.e., curative operation cannot be achieved).10 Advanced stages were seen frequently; seen in cases of noncurative resection and palliative opthere were 1, 3, 4, 6, and 12 cases in stages I, II, IIIa, IIIb, and IV, eration. The cumulative survival rate of the patients was respectively. 87%, 15 years after the operation. A complete responseHematological examination and liver function tests were perwas achieved in one case; the residual lesion in the liver formed every 2 weeks, and serological tests and ultrasound (US) and completely disappeared on the computed tomography computed tomography (CT) scans were carried out at approximately image 3.5 years after noncurative surgery. Palliative or 6-month intervals. The drug protocol for albendazole (200-mg tablets; mass reduction surgery combined with albendazole obtained from SmithKline Beecham, Tokyo, Japan) was 10 mg/kg/d therapy may be a strategy for advanced disease, espe-orally in a treatment cycle of 4 weeks with 2-week breaks.3 This cycle cially when complete resection might result in signifi-was repeated indefinitely unless there were adverse reactions. The average duration of treatment was 3.25 years. cant morbidity or mortality. (HEPATOLOGY 1997;25:The study protocol of chemotherapy was approved by the ethics 528-531.)committee of the Department of Medicine of Hokkaido University. Chemotherapy was performed in patients after their informed conPatients with alveolar echinococcosis of the live...

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Hepatic alveolar echinococcosis: correlative US and CT study.

Cited by 125 publications

References 0 publications

Structured treatment interruption in patients with alveolar echinococcosis

Structured treatment interruption in patients with alveolar echinococcosis

Hydatid Disease: Current Status and Recent Advances

Effect of albendazole on recurrent and residual alveolar echinococcosis of the liver after surgery

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