Hepatic alveolar echinococcosis and primary liver cancer: differential diagnosis with contrast-enhanced ultrasound_West China Medical Journal

Authors：

YAN Shanling ¹ ,  LU Qiang ² , ZHENG Hong ¹ , LI Cheng ¹

1. Department of Ultrasound, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;
2. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

LU Qiang, Email: wsluqiang@126.com

Keywords：

Ultrasound; Contrast agent; Liver cancer; Hepatic alveolar echinococcosis

DOI：

10.7507/1002-0179.201601225

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Objective To determine the value of contrast-enhanced ultrasound (CEUS) in the differentiation of primary liver cancer (PLC) and hepatic alveolar echinococcosis (HAE). Methods The data of 56 patients with PLC or HAE were collected between January 2010 and May 2015. Grayscale and CEUS features of the patients were analyzed retrospectively. The frequency of each imaging finding, including calcification, arterial enhancement, and internal enhancement were evaluated and compared. Results Statistically significant difference of the proportion of gender and age were detected between the two groups (P=0.013, 0.002). Thirty-eight PLC lesions were detected in 32 patients. The diameters of PLC lesions were 3-10 cm with an average of (5.6±2.1) cm. Thirty-two HAE lesions were found in 24 patients. The diameters of HAE lesions were 4-12 cm with an average of (9.1±4.4) cm. Statistically significant difference of lesion size and the incidence rate of calcification (5.3% vs. 75.0%) were seen between PLC and HAE (P<0.001). Peripheral enhancement were seen in 100.0% (38/38) PLC lesions, including 84.2% (32/38) hyperenhancement and 15.8% (6/38) dendritic hyperenhancement. All PLC lesions demonstrated hypoenhancement in late phase. Irregular peripherally hyperenhancement both in arterial and late phase were detected in 43.8% (14/32) HAE lesions. The other 56.2% (18/32) HAE lesions showed no peripheral enhancement both in arterial and late phase. No internal enhancement were seen in HAE lesions. The presence of arterial enhancement (100.0% vs. 43.8%) and absence of internal enhancement (0 vs. 100.0%) were significantly different between PLC and HAE (P<0.001). Conclusions PLC is predicted by arterial phase hyperenhancement and late phase hypoenhancement on CEUS. HAE is predicted with calcification on baseline sonography and internal non-enhancement on CEUS. Arterial phase enhancement is less common and less intensive in HAE than in PLC which also contributes to the differentiation of these lesions.

Citation： YAN Shanling, LU Qiang, ZHENG Hong, LI Cheng. Hepatic alveolar echinococcosis and primary liver cancer: differential diagnosis with contrast-enhanced ultrasound. West China Medical Journal, 2017, 32(7): 1037-1041. doi: 10.7507/1002-0179.201601225 Copy

1.	唐一植, 李倩, 蔣煒. 超聲造影對肝泡型包蟲病的鑒別診斷價值. 四川醫學, 2013, 34(7): 1088-1090.
2.	譚洪亮, 李人立, 宋潔. 肝泡型包蟲病肝內外轉移及其與肝癌的鑒別診斷. 現代腫瘤醫學, 2016(2): 276-278.
3.	路越晴, 鄧勇, 張靈強, 等. 泡型肝包蟲病的臨床治療進展. 中國普外基礎與臨床雜志, 2016, 23(5): 547-551.
4.	陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.
5.	盧強, 黃子星, 鐘曉緋, 等. 超聲造影在肝臟局灶性結節樣增生診斷中的應用. 中國普外基礎與臨床雜志, 2010, 17(4): 403-406.
6.	周如海, 袁瑞, 趙平, 等. 實時超聲造影成像在肝臟局灶性病變中的應用研究. 醫學影像學雜志, 2010, 20(2): 291-293.
7.	Bosch FX, Ribes J, Cleries R, et al. Epidemiology of hepatocellular carcinoma. Clin Liver Dis, 2005, 9(2): 191-211.
8.	Barreiros AP, Piscaglia F, Dietrich CF. Contrast enhanced ultrasound for the diagnosis of hepatocellular carcinoma (HCC): comments on AASLD guidelines. J Hepatol, 2012, 57(4): 930-932.
9.	Claudon M, Dietrich CF, Choi B, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative incooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med, 2013, 34(1): 11-29.
10.	Xu JF, Liu HY, Shi Y, et al. Evaluation of hepatocellular carcinoma by contrast-enhanced sonography correlation with pathologic differentiation. J Ultrasound Med, 2011, 30(5): 625-633.
11.	Jang HJ, Kim TK, Burns PN, et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology, 2007, 244(3): 898-906.
12.	Reuter S, Nussle K, Kolokythas O, et al. Alveolar liver echinococcosis: a comparative study of three imaging techniques. Infection, 2001, 29(3): 119-125.
13.	Ehrhardt AR, Reuter S, Buck AK, et al. Assessment of disease activity in alveolar echinococcosis: a comparison ofcontrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography. Abdom Imaging, 2007, 32(6): 730-736.
14.	楊秉輝, 叢文銘, 周曉軍, 等. 原發性肝癌規范化診治的專家共識. 實用肝臟病雜志, 2009, 12(5): 321-328.
15.	El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 2012, 142(6): 1264-1273.
16.	Harada K, Hirohara J, Ueno Y, et al. Incidence of and risk factors for hepatocellular carcinoma in primary biliary cirrhosis: national data from Japan. Hepatology, 2013, 57(5): 1942-1949.
17.	Kim TK, Jang HJ. Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis. World J Gastroenterol, 2014, 20(13): 3590-3596.
18.	馬淑梅, 鄭云慧, 樊海寧, 等. 超聲造影參數對肝泡型包蟲病灶邊緣浸潤帶的分析研究. 中國超聲醫學雜志, 2016, 32(11): 1001-1003.

1. 唐一植, 李倩, 蔣煒. 超聲造影對肝泡型包蟲病的鑒別診斷價值. 四川醫學, 2013, 34(7): 1088-1090.
2. 譚洪亮, 李人立, 宋潔. 肝泡型包蟲病肝內外轉移及其與肝癌的鑒別診斷. 現代腫瘤醫學, 2016(2): 276-278.
3. 路越晴, 鄧勇, 張靈強, 等. 泡型肝包蟲病的臨床治療進展. 中國普外基礎與臨床雜志, 2016, 23(5): 547-551.
4. 陳哲宇. 泡型肝包蟲病的外科治療現狀. 中國普外基礎與臨床雜志, 2016, 23(5): 513-516.
5. 盧強, 黃子星, 鐘曉緋, 等. 超聲造影在肝臟局灶性結節樣增生診斷中的應用. 中國普外基礎與臨床雜志, 2010, 17(4): 403-406.
6. 周如海, 袁瑞, 趙平, 等. 實時超聲造影成像在肝臟局灶性病變中的應用研究. 醫學影像學雜志, 2010, 20(2): 291-293.
7. Bosch FX, Ribes J, Cleries R, et al. Epidemiology of hepatocellular carcinoma. Clin Liver Dis, 2005, 9(2): 191-211.
8. Barreiros AP, Piscaglia F, Dietrich CF. Contrast enhanced ultrasound for the diagnosis of hepatocellular carcinoma (HCC): comments on AASLD guidelines. J Hepatol, 2012, 57(4): 930-932.
9. Claudon M, Dietrich CF, Choi B, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative incooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med, 2013, 34(1): 11-29.
10. Xu JF, Liu HY, Shi Y, et al. Evaluation of hepatocellular carcinoma by contrast-enhanced sonography correlation with pathologic differentiation. J Ultrasound Med, 2011, 30(5): 625-633.
11. Jang HJ, Kim TK, Burns PN, et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology, 2007, 244(3): 898-906.
12. Reuter S, Nussle K, Kolokythas O, et al. Alveolar liver echinococcosis: a comparative study of three imaging techniques. Infection, 2001, 29(3): 119-125.
13. Ehrhardt AR, Reuter S, Buck AK, et al. Assessment of disease activity in alveolar echinococcosis: a comparison ofcontrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography. Abdom Imaging, 2007, 32(6): 730-736.
14. 楊秉輝, 叢文銘, 周曉軍, 等. 原發性肝癌規范化診治的專家共識. 實用肝臟病雜志, 2009, 12(5): 321-328.
15. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 2012, 142(6): 1264-1273.
16. Harada K, Hirohara J, Ueno Y, et al. Incidence of and risk factors for hepatocellular carcinoma in primary biliary cirrhosis: national data from Japan. Hepatology, 2013, 57(5): 1942-1949.
17. Kim TK, Jang HJ. Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis. World J Gastroenterol, 2014, 20(13): 3590-3596.
18. 馬淑梅, 鄭云慧, 樊海寧, 等. 超聲造影參數對肝泡型包蟲病灶邊緣浸潤帶的分析研究. 中國超聲醫學雜志, 2016, 32(11): 1001-1003.

West China Medical Journal

Hepatic alveolar echinococcosis and primary liver cancer: differential diagnosis with contrast-enhanced ultrasound

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