• Echinococcus multilocularis
• alveolar echinococcosis
• diagnostic techniques
• parasite

• 2017YFA0205201 the Major State Basic Research Development Program of China
• 81925019 the National Natural Science Foundation of China
• U1705281 the National Natural Science Foundation of China
• 20720190088 the Fundamental Research Funds for the Central Universities
• 20720200019 the Fundamental Research Funds for the Central Universities
• 2020Y4003 the Science Foundation of Fujian Province
• 201812631010 the Science Foundation of Fujian Province
• NCET-13-0502 the Program for New Century Excellent Talents in University, China
• GZC20231414 the Postdoctoral Fellowship Program of CPSF

• Apparent diffusion coefficient
• Liver imaging
• diffusion-weighted MRI
• integrated slice-specific dynamic shimming EPI
• single-shot EPI

• Humans
• Diffusion Magnetic Resonance Imaging/methods
• Female
• Male
• Middle Aged
• Adult
• Aged
• Liver Neoplasms/diagnostic imaging
• Echo-Planar Imaging/methods
• Sensitivity and Specificity
• Reproducibility of Results
• Image Enhancement/methods
• Aged, 80 and over
• Image Interpretation, Computer-Assisted/methods
• Young Adult
• Liver Diseases/diagnostic imaging

• Echinococcus multilocularis
• Kashmir
• albendazole
• alveolar echinococcosis
• echinococcosis
• hydatidosis
• praziquantel

• There is no formal system of grants. It is a trust that supports our research. Dr. Khuroo' Medical Trust.

• Humans
• Animals
• Mice
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcosis, Hepatic/pathology
• Magnetic Resonance Imaging/methods
• Diffusion Magnetic Resonance Imaging/methods

• FDG-PET
• MRI
• PET/MR
• alveolar echinococcosis
• liver imaging

• CT
• MRI
• US
• alveolar echinococcosis
• imaging

Alveolar echinococcosis (AE) is one of the most dangerous human parasitoses. The main site of disease manifestation is the liver (about 98 %). The Echinococcus Multilocularis Ulm Classification for Computed Tomography (EMUC-CT), presented in 2016, was the first compilation of CT morphological criteria of hepatic AE. Studies based on EMUC-CT made it possible to draw conclusions about the development of the lesions in the course of disease beyond purely diagnostic typing. Among the most important findings of these precursor studies was that EMUC-CT type IV presented as an initial lesion, whereas EMUC-CT type III lesions were mostly associated with an advanced disease constellation. An intermodal view of image morphological criteria provides further multi-layered indications for lesion evolution.

With the “Alveolar Echinococcosis Ulm Classification” (AEUC), a revision of the previous EMUC-CT was carried out with stage-oriented reorganization of the primary morphologies. Furthermore, an intermodal classification scheme for the evolution of hepatic AE lesions based on AEUC, MRI Kodama classification, and aspects of ultrasound could be outlined.

The first stage-oriented CT classification of hepatic AE “AEUC” is based with respect to its lesion characterization on the separate consideration of two classification pillars, the five “primary morphologies”, AEUC I–V (AEUC II–IV with subcriteria) and the five “patterns of calcification”. In addition, an intermodal classification scheme presents five stages of lesion evolution: “initial stage”, “progressive stage”, “advanced stage”, “transitional stage” and “regressive stage”.

The imaging modalities differ with respect to their visualization of lesion criteria. This underlines the need for unimodal classification systems. Staging of an AE lesion can be done more accurately by evaluating different modalities.

• Alveolar echinococcosis
• Echinococcus multilocularis
• Kodama classification
• extrahepatic manifestation
• magnetic resonance imaging
• vascular/biliary involvement

To study the spectrum of imaging findings in hepatic alveolar echinococcosis (HAE) and to evaluate the potential role of diffusion-weighted imaging (DWI) in its characterisation.

Two radiologists with more than seven years of experience retrospectively studied ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) findings in 23 histopathologically proven cases of HAE with emphasis on the appearance and extent of disease. DWI characteristics of lesions were noted, and their apparent diffusion values (ADC) were calculated.

Ultrasonography features of HAE included heterogeneous, hyperechoic hepatic mass with or without calcification (n = 20), or heterogeneous mass with solid-cystic appearance (n = 2). CT revealed heterogeneous density infiltrative hepatic mass with no contrast enhancement in 19 patients or thick-walled cystic mass (n = 4). Following Kodama classification one type 1, six type 2, two type 3, eight type 4, and two type 5 lesions were identified on T2-weighted MRI. No enhancement was seen on post-contrast T1-weighted images. Mean ADC values were 1.74 ± 0.48 × 10^-3 mm²/s (range: 1.39 × 10^-3 mm²/s to 2.3 × 10^-3 mm²/s).

HAE by virtue of its infiltrative growth pattern with a tendency to involve biliary, vascular, and extra hepatic structures can be easily misdiagnosed as malignant hepatic neoplasm. Knowledge of varied imaging appearances of HAE is essential to suspect the condition and to make an appropriate diagnosis. Diffusion-weighted imaging is a useful adjunct with relatively high diffusivity (high ADC values) suggesting diagnosis of alveolar hydatid.

• apparent diffusion coefficient
• computed tomography
• diffusion-weighted imaging
• hepatic alveolar echinococcosis (HAE)
• magnetic resonance imaging

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.

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

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).

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.

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.

• Alveolar echinococcosis
• Echinococcus multilocularis
• Echinococcus multilocularis Ulm classification for computed tomography
• Vascular/biliary involvement
• Extrahepatic manifestation
• XUUB project

• Animals
• China/epidemiology
• Echinococcosis
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcosis, Hepatic/epidemiology
• Europe
• France
• Germany
• Humans
• Retrospective Studies

• Hepatic alveolar echinococcosis
• Ultrasound classification

• Cystic echinococcosis
• alveolar echinococcosis
• concurrence
• positron emission tomography

More than 70% of hepatic alveolar echinococcosis (HAE) are inoperable. Thus, long-term, or even life-long, pharmacological treatment with benzimidazoles is necessary. For effective treatment, it is of great importance to employ imaging techniques to detect and monitor the non-resectable parasitic viability. Therefore, this study aimed to evaluate diffusion-weighted imaging (DWI) in assessing the viability of HAE in comparison to 18-fluoro-deoxyglucose (18F-FDG) positron emission tomography, combined with computed tomography (PET/CT).

Positron emission tomography, computed tomography and DWI (b-values: 0, 800 s/mm²) were retrospectively analysed in eight patients with clinically-verified HAE to, generate the apparent diffusion coefficient (ADC) map. The activity of HAE lesions in both techniques were determined independently by two radiologists according to the following standard: (+), marked focally or perilesionally increased FDG uptake/high signal intensity; (−), a hepatic defect without FDG uptake/no high signal intensity. Every lesion's maximum standardized uptake value (SUV_max) on the PET/CT images and mean ADC values on the parametric ADC maps were measured respectively. Results of PET/CT and DWI were compared on a per-lesion-basis. Pearson's correlation coefficient was assessed for statistical analysis.

A total of 14 HAE lesions were detected. Eight lesions (diameter 3–15 cm) showed perilesional hyper-signal intensity on DWI. This was visualised on PET/CT as increased FDG uptake. They mainly existed in the lesion's border with normal liver parenchyma. Five lesions (diameter < 2 cm) were detected as nodular hyperintensity on DWI and a ‘hot spot’ on PET/CT in the same distribution. One patient, who had received oral drug therapy for three years showed significantly decreased perilesional hyperintensity on the DWI and a hepatic defect without any FDG uptake on PET/CT. Pearson's correlation coefficient indicated a significant inverse correlation of the ADC and the SUV_max (r = −0.67, p < 0.001).

Diffusion-weighted imaging is capable of offering information on visually detecting the HAE lesions' viability and may be useful for routine application in the initial diagnosis of HAE.

• Diffusion-weighted imaging
• Echinococcosis
• Liver
• MRI
• PET/CT

• Liver
• alveolar echinococcosis
• computed tomography perfusion imaging

• Alveolar echinococcosis
• Apparent diffusion coefficient (ADC)
• Diffusion magnetic resonance imaging
• Hepatocellular carcinoma
• Intrahepatic cholangiocarcinoma

• Adult
• Aged
• Carcinoma, Hepatocellular/diagnostic imaging
• Case-Control Studies
• Cholangiocarcinoma/diagnostic imaging
• Diffusion Magnetic Resonance Imaging
• Echinococcosis, Hepatic/diagnostic imaging
• Female
• Humans
• Liver Neoplasms/diagnostic imaging
• Male
• Middle Aged

• Adult
• Albendazole/therapeutic use
• Anthelmintics/therapeutic use
• Echinococcosis, Hepatic/diagnosis
• Echinococcosis, Hepatic/drug therapy
• Echinococcosis, Hepatic/surgery
• Female
• Follow-Up Studies
• Humans
• Liver Transplantation
• Male
• Middle Aged
• Prognosis
• Retrospective Studies
• Survival Rate

To investigate the utility of computed 3T diffusion-weighted imaging (c-DWI) for the diagnosis of non-complicated hepatic cysts with a focus on the T2 shine-through effect.

In 50 patients with non-complicated hepatic cysts we acquired one set of DWIs (b-value 0 and 1000 s/mm²) at 1.5T, and two sets at 3T (b-value 0 and 1000 s/mm², TE 70 ms; b-value 0 and 600 s/mm², TE 60 ms). We defined the original DWIs acquired with b = 1000 s/mm² at 1.5T and 3T as “o-1.5T-1000” and “o-3T-1000”. c-DWIs were calculated with 3T DWI at b-values of 0 and 600 s/mm². c-DWI with b = 1000 and 1500 s/mm² were defined as “c-1000” and “c-1500”. Radiologists evaluated the signal intensity (SI) of the cysts using a 3-point score where 1 = not visible, 2 = discernible, and 3 = clearly visible. They calculated the contrast ratio (CR) between the cysts and the surrounding liver parenchyma on each DWIs and recorded the apparent diffusion coefficient (ADC) with a b-value = 0 and 1000 s/mm² on 1.5T- and 3T DWIs.

Compared with o-1.5T-1000 DWI, the visual scores of all but the c-1500 DWIs were higher (p = 0.07 for c-1500- and p < 0.01 for the other DWIs). The CR at b = 1000 s/mm² was higher on o-3T-1000- than on o-1.5T-1000- (p < 0.01) but not higher than on c-1500 DWIs (p = 0.96). The CR at b = 0 s/mm² on 3T images with TE 70 ms was higher than on 1.5T images (p < 0.01). The ADC value was higher for 3T- than 1.5T images (p < 0.01).

Non-complicated hepatic cysts showed higher SI on o-3T-1000- than o-1.5T-1000 DWIs due to the T2-shine through effect. This high SI was suppressed on c-1500 DWIs.

• ADC, apparent diffusion coefficient
• CR, contrast ratio
• Computed diffusion-weighted imaging
• DWI, diffusion-weighted imaging
• Diffusion-weighted imaging
• Field strength
• HCC, hepatocellular carcinoma
• MRI, magnetic resonance imaging
• Non-complicated hepatic cysts
• SI, signal intensity
• SNR, signal-to-noise ratio
• T1-WI, T1-weighted MRI
• T2 shine-through effect
• T2-WI, T2-weighted MRI
• c-DWI, computed diffusion-weighted imaging

Background: This study retrospectively analyzed the clinical data, laboratory results, imaging findings, and histopathological features of 28 patients who underwent ultrasound-guided core-needle biopsy from a hepatic lesion and were diagnosed with alveolar echinococcosis. Results: Among 28 patients included in the study, 16 were females and 12 were males. The mean age of the studied population was 53 ± 16 years, and the age range was 18–79 years. The most common presenting symptom was abdominal pain, which was observed in 14 patients. A total of 36 lesions were detected in the patients’ livers, out of which 7 had a cystic appearance. Hepatic vascular involvement, bile duct involvement, and other organ involvement were depicted in 14, 5, and 7 patients, respectively. The average number of cores taken from the lesions was 2.7, ranging between 2 and 5. In histopathological evaluation, PAS+ parasitic membrane structures were visualized on a necrotic background in all cases. Regarding seven patients, who were operated, the pathological findings of preoperative percutaneous biopsies were in perfect agreement with the pathological examinations after surgical resections. None of the patients developed major complications after biopsy. Conclusion: Ultrasound-guided core-needle biopsy is a minimally invasive, reliable, and effective diagnostic tool for the definitive diagnosis of hepatic alveolar echinococcosis.

Epidemiological studies have demonstrated that most humans infected with Echinococcus spp. exhibit resistance to disease. When infection leads to disease, the parasite is partially controlled by host immunity: in case of immunocompetence, the normal alveolar echinococcosis (AE) or cystic echinococcosis (CE) situation, the metacestode grows slowly, and first clinical signs appear years after infection; in case of impaired immunity (AIDS; other immunodeficiencies), uncontrolled proliferation of the metacestode leads to rapidly progressing disease. Assessing Echinococcus multilocularis viability in vivo following therapeutic interventions in AE patients may be of tremendous benefit when compared with the invasive procedures used to perform biopsies. Current options are F18-fluorodeoxyglucose-positron emission tomography (FDG-PET), which visualizes periparasitic inflammation due to the metabolic activity of the metacestode, and measurement of antibodies against recEm18, a viability-associated protein, that rapidly regresses upon metacestode inactivation. For Echinococcus granulosus, similar prognosis-associated follow-up parameters are still lacking but a few candidates may be listed. Other possible markers include functional and diffusion-weighted Magnetic Resonance Imaging (MRI), and measurement of products from the parasite (circulating antigens or DNA), and from the host (inflammation markers, cytokines, or chemokines). Even though some of them have been promising in pilot studies, none has been properly validated in an appropriate number of patients until now to be recommended for further use in clinical settings. There is therefore still a need to develop reliable tools for improved viability assessment to provide the sufficient information needed to reliably withdraw anti-parasite benzimidazole chemotherapy, and a basis for the development of new alternative therapeutic tools.

Alveolar hydatid disease or alveolar echinococcosis is a disease of the parasite Echinococcus multilocularis that is potentially fatal if left untreated. It primarily involves the liver but can be disseminated to other organs like the lungs and the brain by hematogenous route. Multiorgan involvement and the aggressive appearance of lesions make alveolar hydatid disease easy to confuse with a metastatic malignancy. For this reason, histopathological confirmation is essential for definite diagnosis. We present the imaging features of this disease in two patients in order to emphasize that these lesions can be easily misdiagnosed as malignancies.

• Diffusion Magnetic Resonance Imaging/methods
• Echinococcosis, Hepatic/pathology
• Female
• Humans
• Image Interpretation, Computer-Assisted/methods
• Male