Z Gastroenterol 2021; 59(12): 1309-1321
DOI: 10.1055/a-1645-3138
Übersicht

Ultrasound and contrast-enhanced ultrasound (CEUS) in infective liver lesions

Ultraschall und Kontrastmittelultraschall zur Beurteilung infektiöser Leberläsionen
Nitin Chaubal
1   Thane Ultrasound Centre, Thane, India
2   Jaslok Hospital and Research Centre, Mumbai, India
,
Thomas Thomsen
3   Westküstenklinik Brunsbüttel, Brunsbüttel, Germany
,
Adnan Kabaalioglu
4   Department of Radiology, Koç University Hospital, Istanbul, Turkey
,
David Srivastava
5   Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
,
Stephanie Simone Rösch
5   Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
,
5   Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
› Institutsangaben

Zusammenfassung

Infektiöse fokale Leberläsionen (FLL) treten in der klinischen Praxis häufig auf, wobei bakterielle Leberabszesse die Hälfte ausmachen. Eine genaue Diagnose der FLL ist für die Auswahl der am besten geeigneten Therapie und zur Vorbeugung von Komplikationen unerlässlich. Ziel der aktuellen Arbeit ist es, den Nutzen von Ultraschall und kontrastmittelverstärktem Ultraschall (CEUS) zur Erkennung und Charakterisierung infektiöser Leberläsionen zu beschreiben.

Abstract

Infective focal liver lesions (FLL) are commonly encountered in clinical practice, with bacterial hepatic abscesses accounting for half of the visceral abscesses diagnosed. Accurate diagnosis of suspected hepatic infections is imperative for selecting the most appropriate therapy and preventing complications. The current review aims to update on the use of ultrasound and contrast-enhanced ultrasound (CEUS) to detect and characterize infective liver lesions.



Publikationsverlauf

Eingereicht: 16. Februar 2021

Angenommen nach Revision: 14. September 2021

Artikel online veröffentlicht:
12. November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Dietrich CF, Lorentzen T, Appelbaum L. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Short Version). Ultraschall Med 2016; 37: 27-45
  • 2 Dietrich CF, Lorentzen T, Appelbaum L. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III – Abdominal Treatment Procedures (Long Version). Ultraschall Med 2016; 37: E1-E32
  • 3 Sidhu PS, Brabrand K, Cantisani V. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Long Version). Ultraschall Med 2015; 36: E15-35
  • 4 Sidhu PS, Brabrand K, Cantisani V. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Diagnostic Ultrasound-Guided Interventional Procedures (Short Version). Ultraschall Med 2015; 36: 566-580
  • 5 Ding H, Wang WP, Huang BJ. et al. Imaging of focal liver lesions: low-mechanical-index real-time ultrasonography with SonoVue. J Ultrasound Med 2005; 24: 285-297
  • 6 Dietrich CF, Kratzer W, Strobe D. et al. Assessment of metastatic liver disease in patients with primary extrahepatic tumors by contrast-enhanced sonography versus CT and MRI. World J Gastroenterol 2006; 12: 1699-1705
  • 7 Dietrich CF, Nolsoe CP, Barr RG. et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver – Update 2020 WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultrasound Med Biol 2020; 46: 2579-2604
  • 8 Dietrich CF, Nolsoe CP, Barr RG. et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver – Update 2020 WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS. Ultraschall Med 2020; 41: 562-585
  • 9 Huang DY, Yusuf GT, Daneshi M. et al. Contrast-enhanced US-guided interventions: improving success rate and avoiding complications using US contrast agents. Radiographics 2017; 37: 652-664
  • 10 Dietrich CF, Greis C. How to perform contrast enhanced ultrasound. Dtsch Med Wochenschr 2016; 141: 1019-1024
  • 11 Dietrich CF, Ignee A, Greis C. et al. Artifacts and pitfalls in contrast-enhanced ultrasound of the liver. Ultraschall Med 2014; 35: 108-125
  • 12 Dietrich CF, Ignee A, Hocke M. et al. Pitfalls and artefacts using contrast enhanced ultrasound. Z Gastroenterol 2011; 49: 350-356
  • 13 Bartolotta TV, Vernuccio F, Taibbi A. et al. Contrast-enhanced ultrasound in focal liver lesions: where do we stand?. Semin Ultrasound CT MR 2016; 37: 573-586
  • 14 Kishina M, Koda M, Tokunaga S. et al. Usefulness of contrast-enhanced ultrasound with Sonazoid for evaluating liver abscess in comparison with conventional B-mode ultrasound. Hepatol Res 2015; 45: 337-342
  • 15 Dhamija E. Role of contrast enhanced ultrasound in hepatic imaging. Trop Gastroenterol 2014; 35: 141-151
  • 16 Sparchez Z, Radu P, Sparchez M. et al. Intracavitary applications of ultrasound contrast agents in hepatogastroenterology. J Gastrointestin Liver Dis 2013; 22: 349-353
  • 17 Dietrich CF, Mertens JC, Braden B. et al. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology 2007; 45: 1139-1145
  • 18 Popescu A, Sporea I, Şirli R. et al. Does contrast enhanced ultrasound improve the management of liver abscesses? A single centre experience. Med Ultrason 2015; 17: 451-455
  • 19 Caraiani C, Dong Y, Petresc B, Dietrich CF. Indications for abdominal imaging: When at what to choose?. J Ultrason 2020; 20: e43-e54
  • 20 Kunze G, Staritz M, Köhler M. Contrast-enhanced ultrasound in different stages of pyogenic liver abscess. Ultrasound Med Biol 2015; 41: 952-959
  • 21 Sun K, Zhu W, Luo Y. et al. Transient Segmental enhancement of pyogenic liver abscess: a comparison between contrast-enhanced ultrasound and computed tomography. J Comput Assist Tomogr 2018; 42: 133-138
  • 22 Bächler P, Baladron MJ, Menias C. et al. Multimodality Imaging of liver infections: differential diagnosis and potential pitfalls. Radiographics 2016; 36: 1001-1023
  • 23 Wu M, Zheng QC. Case report: real-time contrast-enhanced ultrasonography for the diagnosis of typical ‘bull’s eye’ sign of hepatic abscess caused by Acinetobacter baumannii in a tumor patient. Exp Ther Med 2016; 11: 929-932
  • 24 Liu GJ, Lu MD, Xie XY. et al. Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions. J Ultrasound Med 2008; 27: 657-666
  • 25 Yin S, Cui Q, Yan K. et al. Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions. Chin J Cancer Res 2017; 29: 272-280
  • 26 Heinzmann A, Müller T, Leitlein J. et al. Endocavitary contrast enhanced ultrasound (CEUS)—work in progress. Ultraschall Med 2012; 33: 76-84
  • 27 Barreiros AP, Braden B, Schieferstein-Knauer C. et al. Characteristics of intestinal tuberculosis in ultrasonographic techniques. Scand J Gastroenterol 2008; 43: 1224-1231
  • 28 Dong Y, Jurgensen C, Puri R. et al. Ultrasound imaging features of isolated pancreatic tuberculosis. Endosc Ultrasound 2018; 7: 119-127
  • 29 Feier D, Socaciu M, Anton O. et al. The combined role of intravenous contrast enhanced ultrasound (CEUS) and computed tomography (CT) in liver abscess diagnosis. Chirurgia (Bucur) 2012; 107: 343-351
  • 30 Lodhi S, Sarwari AR, Muzammil M. et al. Features distinguishing amoebic from pyogenic liver abscess: a review of 577 adult cases. Trop Med Int Health 2004; 9: 718-723
  • 31 Barreiros AP, Chiorean L, Braden B, Dietrich CF. Ultrasound in rare diffuse liver disease. Z Gastroenterol 2014; 52: 1247-1256
  • 32 Blessmann J, Le Van A, Tannich E. Hepatic ultrasound in a population with high incidence of invasive amoebiasis: evidence for subclinical, self-limited amoebic liver abscesses. Trop Med Int Health 2003; 8: 231-233
  • 33 Gottschalk U, Ignee A, Dietrich CF. Ultrasound-guided interventions and description of the equipment. Z Gastroenterol 2010; 48: 1305-1316
  • 34 Brunetti E, Tamarozzi F, Macpherson C. et al. Ultrasound and cystic echinococcosis. Ultrasound Int Open 2018; 4: E70-E78
  • 35 Dietrich CF, Sharma M, Gibson RN. et al. Fortuitously discovered liver lesions. World J Gastroenterol 2013; 19: 3173-3188
  • 36 Dietrich CF, Lembcke B, Jenssen C. et al. Intestinal ultrasound in rare gastrointestinal diseases, update, part 1. Ultraschall Med 2014; 35: 400-421
  • 37 Dietrich CF, Lembcke B, Jenssen C. et al. Intestinal ultrasound in rare gastrointestinal diseases, update, part 2. Ultraschall Med 2015; 36: 428-456
  • 38 Dietrich CF, Brunetti E, Chaubal N, Dietrich CF. et al. Ultrasound of tropical (parasitic) diseases. In: EFSUMB Course Book, 2nd ed. EFSUMB; 2020: 1-84
  • 39 Piscaglia F, Wilson SR, Lyshchik A. et al. American College of Radiology Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) for the diagnosis of hepatocellular carcinoma: a pictorial essay. Ultraschall Med 2017; 38: 320-324
  • 40 Dong Y, Mao F, Cao J. et al. Differential diagnosis of gallbladder ascariasis debris: the added value of contrast enhanced ultrasound with high-frequency transducer. Med Ultrason 2018; 20: 413-419
  • 41 Kabaalioglu A, Ceken K, Alimoglu E. et al. Hepatic toxocariasis: US, CT and MRI findings. Ultraschall Med 2005; 26: 329-332
  • 42 Dietrich CF, Cretu CM, Atkinson NSS. et al. Imaging of toxocariasis. Z Gastroenterol 2019; 57: 327-334
  • 43 Baldisserotto M, Conchin CF, Soares MaG. et al. Ultrasound findings in children with toxocariasis: report on 18 cases. Pediatr Radiol 1999; 29: 316-319
  • 44 Harmsen FR, Domagk D, Dietrich CF, Hocke M. Discriminating chronic pancreatitis from pancreatic cancer: contrast-enhanced EUS and multidetector computed tomography in direct comparison. Endosc Ultrasound 2018; 7: 395-403
  • 45 Dietrich CF, Kabaalioglu A, Brunetti E, Richter J. Fasciolosis. Z Gastroenterol 2015; 53: 285-290
  • 46 Kabaalioglu A, Ceken K, Alimoglu E. et al. Hepatobiliary fascioliasis: sonographic and CT findings in 87 patients during the initial phase and long-term follow-up. AJR Am J Roentgenol 2007; 189: 824-828
  • 47 Sarda AK, Kannan R. Visceral larva migrans masquerading as liver secondaries. J Indian Med Assoc 1992; 90: 302
  • 48 Chang S, Lim JH, Choi D. et al. Hepatic visceral larva migrans of Toxocara canis: CT and sonographic findings. AJR Am J Roentgenol 2006; 187: W622-W629
  • 49 Dietrich CF, Cretu C, Dong Y. Imaging of toxocariasis. Adv Parasitol 2020; 109: 165-187
  • 50 Kabaalioglu A, Apaydin A, Sindel T. et al. US-guided gallbladder aspiration: a new diagnostic method for biliary fascioliasis. Eur Radiol 1999; 9: 880-882
  • 51 Kabaalioglu A, Ceken K, Saba R. et al. Pediatric fascioliasis: report of three cases. Turk J Pediatr 2003; 45: 51-54
  • 52 Kabaalioglu A, Cubuk M, Senol U. et al. Fascioliasis: US, CT, and MRI findings with new observations. Abdom Imaging 2000; 25: 400-404
  • 53 Weiss D, Marti G, Mouton W. et al. Infection with fasciola hepatica—a case series. Ultraschall Med 2010; 31: 175-181
  • 54 Dietrich CF, Potthoff A, Helmberger T. et al. Contrast-enhanced ultrasound: Liver Imaging Reporting and Data System (CEUS LI-RADS). Z Gastroenterol 2018; 56: 499-506
  • 55 Kim TY, Lee YS, Yun JH. et al. A case of probable mixed-infection with Clonorchis sinensis and Fasciola sp.: CT and parasitological findings. Korean J Parasitol 2010; 48: 157-160
  • 56 Lim JH, Mairiang E, Ahn GH. Biliary parasitic diseases including clonorchiasis, opisthorchiasis and fascioliasis. Abdom Imaging 2008; 33: 157-165
  • 57 Marcos LA, Terashima A, Gotuzzo E. Update on hepatobiliary flukes: fascioliasis, opisthorchiasis and clonorchiasis. Curr Opin Infect Dis 2008; 21: 523-530
  • 58 Jang YJ, Byun JH, Yoon SE. et al. Hepatic parasitic abscess caused by clonorchiasis: unusual CT findings of clonorchiasis. Korean J Radiol 2007; 8: 70-73
  • 59 Liao WC, Wang HP, Chiu HM. et al. Multiple hepatic nodules: rare manifestation of clonorchiasis. J Gastroenterol Hepatol 2006; 21: 1497-1500
  • 60 Dietrich CF, Atkinson NSS, Lee WJ. et al. Never seen before? Opisthorchiasis and Clonorchiasis. Z Gastroenterol 2018; 56: 1513-1520
  • 61 WHO Informal Working Group. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 2003; 85: 253-261
  • 62 Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Tropica 2010; 114: 1-16
  • 63 Dietrich CF, Douira-Khomsi W, Gharbi H. et al. Cystic and alveolar echinococcosis of the hepatobiliary tract—the role of new imaging techniques for improved diagnosis. Med Ultrason 2020; 22: 77-86
  • 64 Ehrhardt AR, Reuter S, Buck AK. et al. Assessment of disease activity in alveolar echinococcosis: a comparison of contrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography. Abdom Imaging 2007; 32: 730-736
  • 65 Dietrich CF, Mueller G, Beyer-Enke S. Cysts in the cyst pattern. Z Gastroenterol 2009; 47: 1203-1207
  • 66 Dietrich CF, Douira-Khomsi W, Gharbi H. et al. Cystic and alveolar echinococcosis of the hepatobiliary tract—the role of new imaging techniques for improved diagnosis. Med Ultrason 2020; 22: 75-84
  • 67 Dietrich CF, Douira-Khomsi W, Gharbi H. et al. Cystic echinococcosis, review and illustration of non-hepatic manifestations. Med Ultrason 2020; 22: 319-324
  • 68 Dietrich CF, Schreiber-Dietrich D, Schuessler G. et al. Contrast enhanced ultrasound of the liver--state of the art. Dtsch Med Wochenschr 2007; 132: 1225-1231
  • 69 Claudon M, Cosgrove D, Albrecht T. et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) – update 2008. Ultraschall Med 2008; 29: 28-44
  • 70 Schwarze V, Mueller-Peltzer K, Negrão de Figueiredo G. et al. The use of contrast-enhanced ultrasound (CEUS) for the diagnostic evaluation of hepatic echinococcosis. Clin Hemorheol Microcirc 2018; 70: 449-455
  • 71 Dong Y, Wang WP, Mao F. et al. Imaging features of fibrolamellar hepatocellular carcinoma with contrast-enhanced ultrasound. Ultraschall Med 2021; 42: 306-313
  • 72 Dietrich CF, Tannapfel A, Jang HJ. et al. Ultrasound imaging of hepatocellular adenoma using the new histology classification. Ultrasound Med Biol 2019; 45: 1-10
  • 73 Dietrich CF, Averkiou M, Nielsen MB. et al. How to perform Contrast-enhanced ultrasound (CEUS). Ultrasound Int Open 2018; 4: E2-E15
  • 74 Hosch W, Junghanss T, Stojkovic M. et al. Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents. NMR Biomed 2008; 21: 734-754
  • 75 Chiorean L, Cui XW, Klein SA. et al. Clinical value of imaging for lymph nodes evaluation with particular emphasis on ultrasonography. Z Gastroenterol 2016; 54: 774-790
  • 76 Chiorean L, Barr RG, Braden B. et al. Transcutaneous ultrasound: elastographic lymph node evaluation. current clinical applications and literature review. Ultrasound Med Biol 2016; 42: 16-30
  • 77 Schreiber-Dietrich D, Pohl M. et al. Perihepatic lymphadenopathy in children with chronic viral hepatitis. J Ultrason 2015; 15: 137-150
  • 78 Cui XW, Hocke M, Jenssen C. et al. Conventional ultrasound for lymph node evaluation, update 2013. Z Gastroenterol 2014; 52: 212-221
  • 79 Cui XW, Jenssen C, Saftoiu A. et al. New ultrasound techniques for lymph node evaluation. World J Gastroenterol 2013; 19: 4850-4860
  • 80 Braden B, Faust D, Ignee A. et al. Clinical relevance of perihepatic lymphadenopathy in acute and chronic liver disease. J Clin Gastroenterol 2008; 42: 931-936
  • 81 Hirche TO, Russler J, Braden B. et al. Sonographic detection of perihepatic lymphadenopathy is an indicator for primary sclerosing cholangitis in patients with inflammatory bowel disease. Int J Colorectal Dis 2004; 19: 586-594
  • 82 Dietrich CF, Stryjek-Kaminska D, Teuber G. et al. Perihepatic lymph nodes as a marker of antiviral response in patients with chronic hepatitis C infection. AJR Am J Roentgenol 2000; 174: 699-704
  • 83 Dietrich CF, Lee JH, Herrmann G. et al. Enlargement of perihepatic lymph nodes in relation to liver histology and viremia in patients with chronic hepatitis C. Hepatology 1997; 26: 467-472
  • 84 Claudon M, Dietrich CF, Choi BI. et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the Liver – update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210
  • 85 Claudon M, Dietrich CF, Choi BI. et al. Guidelines and Good Clinical Practice Recommendations for Contrast-Enhanced Ultrasound (CEUS) in the liver – update 2012: a WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med 2013; 34: 11-29
  • 86 Zhou LQ, Wang JY, Yu SY. et al. artificial intelligence in medical imaging of the liver. World J Gastroenterol 2019; 25: 672-682
  • 87 Wu GG, Zhou LQ, Xu JW. et al. Artificial intelligence in breast ultrasound. World J Radiol 2019; 11: 19-26
  • 88 Mueller MC, Marx M, Peyerl-Hoffmann G, Kern WV. Spatial distribution and incidence trend of human alveolar echinococcosis in southwest Germany: increased incidence and urbanization of the disease?. Infection 2020; 48: 923-927
  • 89 Kaltenbach TE, Graeter T, Mason RA. et al. Determination of vitality of liver lesions by alveolar echinococcosis. Comparison of parametric contrast enhanced ultrasound (SonoVue®) with quantified 18F-FDG-PET-CT. Nuklearmedizin 2015; 54: 43-49
  • 90 Li J, Dong J, Yang L, Li X, Song T. Comparison of [(18)F]fluorodeoxyglucose positron emission tomography and contrast-enhanced ultrasound for evaluation of hepatic alveolar echinococcosis activity. Ultrasound Med Biol 2018; 44: 2199-2208
  • 91 Zhang H, Liu ZH, Zhu H. et al. Analysis of contrast–enhanced ultrasound (CEUS) and pathological images of hepatic alveolar echinococcosis (HAE) lesions. Eur Rev Med Pharmacol Sci 2016; 20: 1954-1960
  • 92 Liu W, Delabrousse É, Blagosklonov O. et al. Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones. Parasite 2014; 21: 74
  • 93 Richter J, Azoulay D, Dong Y. et al. Ultrasonography of gallbladder abnormalities due to schistosomiasis. Parasitol Res 2016; 115: 2917-2924
  • 94 Richter J, Botelho MC, Holtfreter MC. et al. Ultrasound assessment of schistosomiasis. Z Gastroenterol 2016; 54: 653-660
  • 95 Richter J, Domingues AL, Barata CH. et al. Report of the second satellite symposium on ultrasound in schistosomiasis. Mem Inst Oswaldo Cruz 2001; 96: 151-156
  • 96 Richter J. Evolution of schistosomiasis-induced pathology after therapy and interruption of exposure to schistosomes: a review of ultrasonographic studies. Acta Trop 2000; 77: 111-131
  • 97 Richter J, Zwingenberger K, Ali QM. et al. Hepatosplenic schistosomiasis: comparison of sonographic findings in Brazilian and Sudanese patients—correlation of sonographic findings with clinical symptoms. Radiology 1992; 184: 711-716
  • 98 Pinto-Silva RA, Queiroz LC, Azeredo LM. et al. Ultrasound in schistosomiasis mansoni. Mem Inst Oswaldo Cruz 2010; 105: 479-484
  • 99 White NJ. Melioidosis. Lancet 2003; 361: 1715-1722
  • 100 Morse LP, Moller CC, Harvey E. et al. Prostatic abscess due to Burkholderia pseudomallei: 81 cases from a 19-year prospective melioidosis study. J Urol 2009; 182: 542-547
  • 101 Apisarnthananarak P, Apisarnthanarak A, Mundy LM. Computed tomography characteristics of Burkholderia pseudomallei-associated liver abscess. Clin Infect Dis 2006; 43: 1618-1620
  • 102 Muttarak M, Peh WC, Euathrongchit J. et al. Spectrum of imaging findings in melioidosis. Br J Radiol 2009; 82: 514-521
  • 103 Alsaif HS, Venkatesh SK. Melioidosis: spectrum of radiological manifestations. Saudi J Med Med Sci 2016; 4: 74-78
  • 104 Khiangte HL, Vimala LR, Eapen A. et al. a retrospective case-control study to evaluate the diagnostic accuracy of honeycomb sign in melioid liver abscess. Am J Trop Med Hyg 2018; 99: 852-857
  • 105 Apisarnthanarak P, Thairatananon A, Muangsomboon K. et al. Computed tomography characteristics of hepatic and splenic abscesses associated with melioidosis: a 7-year study. J Med Imaging Radiat Oncol 2011; 55: 176-182
  • 106 Wibulpolprasert B, Dhiensiri T. Visceral organ abscesses in melioidosis: sonographic findings. J Clin Ultrasound 1999; 27: 2934
  • 107 Lu Q, Ling WW, Ma L. et al. Contrast-enhanced ultrasonographic findings of hepatic paragonimiasis. World J Gastroenterol 2013; 19: 2087-2091