Department of Internal Medicine I, University Hospital Ulm, Ulm 89081, Germany.
World J Gastroenterol. 2021 Oct 28;27(40):6939-6950. doi: 10.3748/wjg.v27.i40.6939.
When infects humans as a false intermediate host, alveolar echinococcosis (AE) usually manifests primarily intrahepatically and is initially asymptomatic. If the disease remains undiagnosed and untreated, progressive growth occurs, reminiscent of malignant tumours. The only curative therapy is complete resection, which is limited to localised stages, and palliative drug therapy is used otherwise. Consequently, early diagnosis and reliable detection of AE lesions are important. For this reason, abdominal ultrasonography, as the most common primary imaging for AE, relies on classification systems.
To investigate how hepatic AE lesion sonomorphology changes over time in the Echinococcosis Multilocularis Ulm Classification (EMUC)-ultrasound (US) classification.
Based on data from Germany's national echinococcosis database, we evaluated clinical and US imaging data for 59 patients according to the AE case definition in our preliminary retrospective longitudinal study. There had to be at least two liver sonographies ≥ 6 mo apart, ≥ 1 hepatic AE lesion, and complete documentation in all US examinations. The minimum interval between two separately evaluated US examinations was 4 wk. The AE reference lesion was the largest hepatic AE lesion at the time of the first US examination. To classify the sonomorphologic pattern, we used EMUC-US. In addition to classifying the findings of the original US examiner, all reference lesions at each examination time point were assigned EMUC-US patterns in a blinded fashion by two investigators experienced in US diagnosis. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, United Stated). values < 0.05 were considered statistically significant.
The preliminary study included 59 patients, 38 (64.5%) women and 21 (35.6%) men. The mean age at initial diagnosis was 59.9 ± 16.9 years. At the time of initial ultrasonography, a hailstorm pattern was present in 42.4% (25/59) of cases, a hemangioma-like pattern in 16.9% (10/59), a pseudocystic pattern in 15.3% (9/59), and a metastasis-like pattern in 25.4% (15/59). For the hailstorm pattern, the average lesion size was 67.4 ± 26.3 mm. The average lesion size was 113.7 ± 40.8 mm with the pseudocystic pattern and 83.5 ± 27.3 mm with the hemangioma-like pattern. An average lesion size of 21.7 ± 11.0 mm was determined for the metastasis-like pattern. Although the sonomorphologic pattern remained unchanged in 84.7% (50/59) of AE reference lesions, 15.3% (9/59) showed a change over time. A change in pattern was seen exclusively for AE lesions initially classified as hemangioma-like or pseudocystic. A total of 70% (7/10) of AE lesions initially classified as hemangioma-like showed a relevant change in pattern over time, and 85.7% (6/7) of these were secondarily classified as having a hailstorm pattern, with the remainder (1/7; 14.3%) classified as having a pseudocystic pattern. A total of 22.2% (2/9) of AE lesions initially classified as pseudocystic showed a relevant change in pattern over time and were classified as having a hailstorm pattern. For AE lesions initially classified as having a hailstorm or metastatic pattern, no pattern change was evident. All patients with pattern change were on continuous drug therapy with albendazole.
The sonomorphology of hepatic AE lesions may change over time. The hemangioma-like and pseudocystic patterns are affected.
当 作为假中间宿主感染人类时，泡型包虫病（AE）通常主要表现为肝内，最初无症状。如果疾病未被诊断和治疗，就会发生进行性生长，类似于恶性肿瘤。唯一的治愈性治疗方法是完全切除，这仅限于局部阶段，否则使用姑息性药物治疗。因此，早期诊断和可靠地检测 AE 病变非常重要。为此，腹部超声检查作为 AE 的最常见原发性影像学检查，依赖于分类系统。
研究在泡型包虫病多房蚴 Ulm 分类（EMUC）-超声（US）分类中，肝泡型包虫病病变的声像形态随时间的变化。
基于德国国家包虫病数据库的数据，我们根据初步回顾性纵向研究中的 AE 病例定义，对 59 名患者的临床和 US 影像学数据进行了评估。所有 US 检查均必须至少有两次间隔≥6 个月的肝脏超声检查，至少有 1 个肝泡型包虫病病变，并且所有 US 检查均有完整的记录。两次单独评估的 US 检查之间的最小间隔为 4 周。AE 参考病变是首次 US 检查时最大的肝泡型包虫病病变。为了对声像形态进行分类，我们使用了 EMUC-US。除了对原始 US 检查者的发现进行分类外，两位经验丰富的 US 诊断专家还对每个检查时间点的所有参考病变进行了 EMUC-US 模式的盲法分类。使用 SAS 版本 9.4（SAS Institute Inc.，Cary，NC，美国）进行统计分析。 值<0.05 被认为具有统计学意义。
初步研究包括 59 名患者，其中 38 名（64.5%）为女性，21 名（35.6%）为男性。初始诊断时的平均年龄为 59.9±16.9 岁。在最初的超声检查中，42.4%（25/59）的病例存在雹暴样模式，16.9%（10/59）的病例存在肝血管瘤样模式，15.3%（9/59）的病例存在假囊肿样模式，25.4%（15/59）的病例存在转移瘤样模式。对于雹暴样模式，平均病变大小为 67.4±26.3mm。假囊肿样模式的平均病变大小为 113.7±40.8mm，肝血管瘤样模式的平均病变大小为 83.5±27.3mm。转移瘤样模式的平均病变大小为 21.7±11.0mm。尽管 84.7%（50/59）的 AE 参考病变的声像形态保持不变，但 15.3%（9/59）的病变在随访过程中发生了变化。仅在最初分类为肝血管瘤样或假囊肿样的 AE 病变中观察到形态变化。总共 70%（7/10）最初分类为肝血管瘤样的 AE 病变在随访过程中出现了相关的形态变化，其中 85.7%（6/7）的病变被重新分类为雹暴样模式，其余（1/7；14.3%）被分类为假囊肿样模式。总共 22.2%（2/9）最初分类为假囊肿样的 AE 病变在随访过程中出现了相关的形态变化，被分类为雹暴样模式。最初分类为雹暴样或转移瘤样的 AE 病变没有形态变化。所有发生形态变化的患者均接受阿苯达唑的连续药物治疗。
肝泡型包虫病病变的声像形态可能会随时间变化。肝血管瘤样和假囊肿样模式受到影响。
