Percutaneous imaging-guided treatment of hydatid liver cysts: do long-term results make it a first choice?
OBJECTIVE
To evaluate the long-term results of percutaneous imaging-guided treatment of hydatid liver cysts.


METHODS
Sixty patients with 77 hydatid liver cysts underwent percutaneous treatment with ultrasonography (US) or computed tomography (CT) guidance. Absolute alcohol and hypertonic saline were used for sclerosing the cysts after aspiration. Prophylactic albendazole treatment was given before and after the procedures. Follow-up US and CT were obtained periodically, and changes in cyst morphology were recorded. Minimum follow-up period for the patients included in this study was 12 months. Serological correlation was also available for a group of patients. The outcome of the procedures were categorized into five groups based on morphological changes observed by imaging.


RESULTS
Procedures were regarded as successful in 80% and unsuccessful in 20% of patients. Failures most often occurred with type III cysts; less than half (39%) of the total type III cysts had a successful outcome. On the other hand, all type I cysts ended up with cure. Anaphylaxis, pneumotorax and severe pain interrupting the procedures were also among the reasons of failure.


CONCLUSIONS
Percutaneous aspiration, injection and reaspiration (PAIR) of types I and II hydatid liver cysts is effective and safe in the long-term. Surgery should no longer be regarded as the first choice treatment in all hydatid liver cysts but should be reserved for type III and certain active type IV cysts.
Kabaalioğlu
Adnan
A
Department of Radiology, Akdeniz University Hospital, Antalya, Turkey. adnank@akdeniz.edu.tr
Ceken
Kağan
K
Alimoglu
Emel
E
Apaydin
Ali
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D015766:Albendazole / Q000627:therapeutic use; D000923:Anticestodal Agents / Q000627:therapeutic use; D002648:Child; D004359:Drug Therapy, Combination; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D012597:Sclerosing Solutions / Q000627:therapeutic use; D013396:Suction; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000923:Anticestodal Agents; D012462:Saline Solution, Hypertonic; D012597:Sclerosing Solutions; D015766:Albendazole