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DOI: 10.1055/a-1710-3669
Stage-Oriented CT Classification and Intermodal Evolution Model in Hepatic Alveolar Echinococcosis
Article in several languages: English | deutschAbstract
Background
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.
Method
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.
Results
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”.
Conclusion
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.
Key Points:
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The AEUC provides a stage-oriented CT classification for hepatic AE.
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Aspects of different modalities allow a more multi-layered view of lesion evolution.
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More accurate staging can be achieved by combining different modalities.
Citation Format
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Graeter T, Schmidberger J. Stage-Oriented CT Classification and Intermodal Evolution Model in Hepatic Alveolar Echinococcosis. Fortschr Röntgenstr 2022; 194: 532 – 544
Key words
computed tomography - intermodal classification - lesion evolution - alveolar echinococcosisPublication History
Received: 25 June 2021
Accepted: 14 October 2021
Article published online:
26 January 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Georg Thieme Verlag KG
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References
- 1 Kern P, Bardonnet K, Renner E. et al. European echinococcosis registry: human alveolar echinococcosis, Europe, 1982–2000. Emerg Infect Dis 2003; 9: 343-349 DOI: 10.3201/eid0903.020341.
- 2 Moro P, Schantz PM. Echinococcosis: a review. Int J Infect Dis 2009; 13: 125-133 DOI: 10.1016/j.ijid.2008.03.037.
- 3 Baumann S, Shi R, Liu W. et al. Worldwide literature on epidemiology of human alveolar echinococcosis: a systematic review of research published in the twenty-first century. Infection 2019; 47: 703-727 DOI: 10.1007/s15010-019-01325-2.
- 4 Romig T, Kratzer W, Kimmig P. et al. An epidemiologic survey of human alveolar echinococcosis in southwestern Germany. Römerstein Study Group. Am J Trop Med Hyg 1999; 61: 566-573 DOI: 10.4269/ajtmh.1999.61.566.
- 5 Torgerson PR, Keller K, Magnotta M. et al. The global burden of alveolar echinococcosis. PLoS Negl Trop Dis 2010; 4: e722 DOI: 10.1371/journal.pntd.0000722.
- 6 Deplazes P, Rinaldi L, Alvarez Rojas CA. et al. Global Distribution of Alveolar and Cystic Echinococcosis. Adv Parasitol 2017; 95: 315-493 DOI: 10.1016/bs.apar.2016.11.001.
- 7 Zhang W, Zhang Z, Wu W. et al. Epidemiology and control of echinococcosis in central Asia, with particular reference to the People’s Republic of China. Acta Trop 2015; 141: 235-243 DOI: 10.1016/j.actatropica.2014.03.014.
- 8 Craig PS. Echinococcosis Working Group in China. Epidemiology of human alveolar echinococcosis in China. Parasitol Int 2006; 55: 221-225 DOI: 10.1016/j.parint.2005.11.034.
- 9 Conraths FJ, Probst C, Possenti A. et al. Potenzial risk factors associated with human alveolar echinococcosis: Systematic review and meta-analysis. PLoS Negl Trop Dis 2017; 11: e0005801 DOI: 10.1371/journal.pntd.0005801.
- 10 Ammann RW, Eckert J. Cestodes. Echinococcus. Gastroenterol Clin North Am 1996; 25: 655-689 DOI: 10.1016/s0889-8553(05)70268-5.
- 11 Eckert J, Deplazes P. Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 2004; 17: 107-135 DOI: 10.1128/cmr.17.1.107-135.2004.
- 12 Hillenbrand A, Gruener B, Kratzer W. et al. Impact of Safe Distance on Long-Term Outcome After Surgical Therapy of Alveolar Echinococcosis. World J Surg 2017; 41: 1012-1018 DOI: 10.1007/s00268-016-3813-6.
- 13 Graeter T, Ehing F, Oeztuerk S. et al. Hepatobiliary complications of alveolar echinococcosis: A long-term follow-up study. World J Gastroenterol 2015; 21: 4925-4932 DOI: 10.3748/wjg.v21.i16.4925.
- 14 Brunetti E, Kern P, Vuitton DA. Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114: 1-16 DOI: 10.1016/j.actatropica.2009.11.001.
- 15 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 DOI: 10.3413/Nukmed-0670-14-05.
- 16 Ricken FJ, Nell J, Grüner B. et al. Albendazole increases the inflammatory response and the amount of Em2-positive small particles of Echinococcus multilocularis (spems) in human hepatic alveolar echinococcosis lesions. PLoS Negl Trop Dis 2017; 11: e0005636 DOI: 10.1371/journal.pntd.0005636.
- 17 Kodama Y, Fujita N, Shimizu T. et al. Alveolar echinococcosis: MR findings in the liver. Radiology 2003; 228: 172-177 DOI: 10.1148/radiol.2281020323.
- 18 Kratzer W, Gruener B, Kaltenbach TE. et al. Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: Echinococcosis multilocularis Ulm classification-ultrasound. World J Gastroenterol 2015; 21: 12392-12402 DOI: 10.3748/wjg.v21.i43.
- 19 Graeter T, Kratzer W, Oeztuerk S. et al. Proposal of a computed tomography classification for hepatic alveolar echinococcosis. World J Gastroenterol 2016; 22: 3621-3631 DOI: 10.3748/wjg.v22.i13.3621.
- 20 Grüner B, Schmidberger J, Drews O. et al. Imaging in alveolar echinococcosis (AE): Comparison of Echinococcus multilocularis classification for computed-tomography (EMUC-CT) and ultrasonography (EMUC-US). Radiology of Infectious Diseases 2017; 4: 70-77 DOI: 10.1016/j.jrid.2017.05.001.
- 21 Kern P, Wen H, Sato N. et al. WHO classification of alveolar echinococcosis: principles and application. Parasitol Int 2006; (Suppl. 55) S283-S287 DOI: 10.1016/j.parint.2005.11.041.
- 22 Graeter T, Shi R, Bao HH. et al. Follow-up in hepatic alveolar echinococcosis under benzimidazole therapy using computed tomography. Chin Med J (Engl) 2020; 133: 1507-1509 DOI: 10.1097/CM9.0000000000000874.
- 23 Graeter T, Bao H, Delabrousse E. et al. Hepatic alveolar echinococcosis: Comparative computed tomography study between two Chinese and two European centres. Chin Med J (Engl) 2020; 19: e00082 DOI: 10.1016/j.fawpar.2020.e00082.
- 24 Graeter T, Bao HH, Shi R. et al. Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis. World J Gastroenterol 2020; 26: 4302-4315 DOI: 10.3748/wjg.v26.i29.4302.
- 25 Engler A, Shi R, Beer M. et al. Simple liver cysts and cystoid lesions in hepatic alveolar echinococcosis: A retrospective cohort study with Hounsfield analysis. Parasite 2019; 26: 54 DOI: 10.1051/parasite/2019057.
- 26 Graeter T, Eberhardt N, Shi R. et al. Hepatic alveolar echinococcosis: Correlation between computed tomography morphology and inflammatory activity in positron emission tomography. Sci Rep 2020; 10: 11808 DOI: 10.1038/s41598-020-68624-9.
- 27 Grimm J, Beck A, Nell J. et al. Combining Computed Tomography and Histology Leads to an Evolutionary Concept of Hepatic Alveolar Echinococcosis. Pathogens 2020; 9: 634 DOI: 10.3390/pathogens9080634.
- 28 Brumpt E, Blagosklonov O, Calame P. et al. AE hepatic lesions: correlation between calcifications at CT and FDG-PET/CT metabolic activity. Infection 2019; 47: 955-960 DOI: 10.1007/s15010-019-01328-z.
- 29 Azizi A, Blagosklonov O, Lounis A. et al. Alveolar echinococcosis: correlation between hepatic MRI findings and FDG-PET/CT metabolic activity. Abdominal Imaging 2015; 40: 56-63 DOI: 10.1007/s00261-014-0183-0.
- 30 Graeter T, Shi R, Bao HH. et al. Intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis: a multicenter cohort study. Acta Radiol 2020; DOI: 10.1177/0284185120951958.
- 31 Brumpt W, Liu W, Graeter T. et al Kodama-XUUB: an informative classification for alveolar echinococcosis hepatic lesions at MRI. Parasite. In press.
- 32 Aoki T, Hagiwara M, Yabuki H. et al. Unique MRI findings for differentiation of an early stage of hepatic alveolar echinococcosis. BMJ Case Rep 2015; 2015 DOI: 10.1136/bcr-2014-208123.
- 33 Becce F, Pomoni A, Uldry E. et al. Alveolar echinococcosis of the liver: diffusion-weighted MRI findings and potential role in lesion characterisation. Eur J Radiol 2014; 83: 625-631 DOI: 10.1016/j.ejrad.2013.12.025.
- 34 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 DOI: 10.1051/parasite/2014072.
- 35 Parry AH, Wani AH, Feroz I. The spectrum of multimodality imaging findings in hepatic alveolar echinococcosis and the potential role of diffusion-weighted imaging in its characterisation. Pol J Radiol 2020; 85: e613-e623 DOI: 10.5114/pjr.2020.101015.
- 36 Tappe D, Zidowitz S, Demmer P. et al. Three-dimensional reconstruction of Echinococcus multilocularis larval growth in human hepatic tissue reveals complex growth patterns. Am J Trop Med Hyg 2010; 82: 126-127 DOI: 10.4269/ajtmh.2010.09-0462.
- 37 Reinehr M, Micheloud C, Grimm F. et al. Pathology of Echinococcosis: A Morphologic and Immunohistochemical Study on 138 Specimens With Focus on the Differential Diagnosis Between Cystic and Alveolar Echinococcosis. Am J Surg Pathol 2020; 44: 43-54 DOI: 10.1097/PAS.0000000000001374.
- 38 Barth TF, Herrmann TS, Tappe D. et al. Sensitive and specific immunohistochemical diagnosis of human alveolar echinococcosis with the monoclonal antibody Em2G11. PLoS Negl Trop Dis 2012; 6: e1877 DOI: 10.1371/journal.pntd.0001877.
- 39 Deplazes P, Gottstein B. A monoclonal antibody against Echinococcus multilocularis Em2 antigen. Parasitology 1991; 103: 41-49 DOI: 10.1017/s0031182000059278.
- 40 Gottstein B, Lachenmayer A, Beldi G. et al. Diagnostic and follow-up performance of serological tests for different forms/courses of alveolar echinococcosis. Food Waterborne Parasitol 2019; 16: e00055 DOI: 10.1016/j.fawpar.2019.e00055.