Format

Send to

Choose Destination
Parasite. 2014;21:74. doi: 10.1051/parasite/2014072. Epub 2014 Dec 23.

Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones.

Author information

1
Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China.
2
Department of Visceral Radiology, University Hospital Jean Minjoz, 25030 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France.
3
WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France - Department of Nuclear Medicine, University Hospital Jean Minjoz, 25030 Besançon, France.
4
Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China.
5
WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France.
6
Department of Hepatic surgery, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China.

Abstract

Hepatic Alveolar Echinococcosis (HAE), caused by larvae of Echinococcus multilocularis, is a rare but potentially lethal parasitic disease. The first diagnostic suspicion is usually based on hepatic ultrasound exam performed because of abdominal symptoms or in the context of a general checkup; HAE diagnosis may thus also be an incidental finding on imaging. The next step should be Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). They play an important role in the initial assessment of the disease; with chest and brain imaging, they are necessary to assess the PNM stage (parasite lesion, neighboring organ invasion, metastases) of a patient with AE. Performed at least yearly, they also represent key exams for long-term follow-up after therapeutic interventions. Familiarity of radiologists with HAE imaging findings, especially in the endemic regions, will enable earlier diagnosis and more effective treatment. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is currently considered to be the only noninvasive, albeit indirect, tool for the detection of metabolic activity in AE. Delayed acquisition of images (3 hrs after FDG injection) enhances its sensitivity for the assessment of lesion metabolism and its reliability for the continuation/withdrawal of anti-parasite treatment. However, sophisticated equipment and high cost widely limit PET/CT use for routine evaluation. Preliminary studies show that new techniques, such as contrast-enhanced ultrasound (US), Dual Energy CT or Spectral CT, and Diffusion-Weighted MRI, might also be useful in detecting the blood supply and metabolism of lesions. However, they cannot be recommended before further evaluation of their reliability in a larger number of patients with a variety of locations and stages of AE lesions.

PMID:
25531446
PMCID:
PMC4273719
DOI:
10.1051/parasite/2014072
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for EDP Sciences Icon for PubMed Central
Loading ...
Support Center