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

Abstract

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.

Stage-Oriented CT Classification and Intermodal Evolution Model in Hepatic Alveolar Echinococcosis

“…Like the international epidemiological CT comparison studies mentioned in the introduction [23,24], two corresponding MRI studies based on the Kodama classification with 200 cases each support a categorization of AE lesions within the intermodal classification scheme of evolution of hepatic AE lesions shown in ▶ Fig. 5a [30,31]. Accordingly, Kodama types 1 and 2 are used to classify early and progressive lesions, Kodama type 3 advanced lesions, and Kodama types 4 and 5 degenerative lesions [30,31,33].…”

“…The evolution of the lesion morphologies is presented in consideration of the most important intermodal aspects (▶ Fig. 5a) [17,[22][23][24][25][26][27][29][30][31]: ▶ Fig. 4 Structured reporting form based on the AEUC.…”

“…The evolution of the lesion morphologies is presented in consideration of the most important intermodal aspects (▶ Fig. 5a) [17,[22][23][24][25][26][27][29][30][31]: ▶ Fig. 3 Sample CT image of the different primary morphologies AEUC I-V (without focus on calcification patterns).…”

“…The evolution of the lesion morphologies is presented in consideration of the most important intermodal aspects ( Fig. 5a ) 17 22 23 24 25 26 27 29 30 31 :…”

Recent advances in ultrasound in the diagnosis and evaluation of the activity of hepatic alveolar echinococcosis

“…The disease burden of AE as estimated using Disability Adjusted Life Years (DALYs) is more than five times that of CE (Dezsényi et al 2021;Wang et al 2020). AE is acknowledged as one of the world's most lethal chronic parasitosis and serious threat to life and health (Dezsényi et al 2021;Fischer et al 2020;Graeter et al 2020b;Wang et al 2020).…”