title: Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones.
abstract: Hepatic Alveolar Echinococcosis (HAE), caused by larvae of Echinococcus multilocularis, is a rare but potentially lethal parasitic disease. The first diagnostic suspicion is usually based on hepatic ultrasound exam performed because of abdominal symptoms or in the context of a general checkup; HAE diagnosis may thus also be an incidental finding on imaging. The next step should be Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). They play an important role in the initial assessment of the disease; with chest and brain imaging, they are necessary to assess the PNM stage (parasite lesion, neighboring organ invasion, metastases) of a patient with AE. Performed at least yearly, they also represent key exams for long-term follow-up after therapeutic interventions. Familiarity of radiologists with HAE imaging findings, especially in the endemic regions, will enable earlier diagnosis and more effective treatment. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is currently considered to be the only noninvasive, albeit indirect, tool for the detection of metabolic activity in AE. Delayed acquisition of images (3 hrs after FDG injection) enhances its sensitivity for the assessment of lesion metabolism and its reliability for the continuation/withdrawal of anti-parasite treatment. However, sophisticated equipment and high cost widely limit PET/CT use for routine evaluation. Preliminary studies show that new techniques, such as contrast-enhanced ultrasound (US), Dual Energy CT or Spectral CT, and Diffusion-Weighted MRI, might also be useful in detecting the blood supply and metabolism of lesions. However, they cannot be recommended before further evaluation of their reliability in a larger number of patients with a variety of locations and stages of AE lesions.
authors.affiliation: Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China.
authors.forename: Wenya
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Visceral Radiology, University Hospital Jean Minjoz, 25030 Besançon, France - WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France.
authors.forename: Éric
authors.initials: É
authors.lastname: Delabrousse
authors.affiliation: WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France - Department of Nuclear Medicine, University Hospital Jean Minjoz, 25030 Besançon, France.
authors.forename: Oleg
authors.initials: O
authors.lastname: Blagosklonov
authors.affiliation: Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Ultrasonography, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China.
authors.forename: Hongchun
authors.initials: H
authors.lastname: Zeng
authors.affiliation: Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Imaging Center, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, PR China.
authors.forename: Yongde
authors.initials: Y
authors.lastname: Qin
authors.affiliation: WHO-Collaborating Centre for Prevention and Treatment of Human Echinococcosis, University of Franche-Comté and University Hospital, 25030 Besançon, France.
authors.forename: Dominique Angèle
authors.initials: DA
authors.lastname: Vuitton
authors.affiliation: Department of Hepatic surgery, First Affiliated Hospital, Xinjiang Medical University Hospital, No. 1 Liyushan road, Urumqi 830011, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wen
mesh_terms: D000359:Aftercare; D000818:Animals; D002114:Calcinosis / Q000000981:diagnostic imaging; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000379:methods* / Q000639:trends; D004443:Echinococcosis; D004444:Echinococcosis, Hepatic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000469:parasitology / Q000473:pathology; D048210:Echinococcus multilocularis / Q000254:growth & development / Q000302:isolation & purification; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D062069:Inventions; D007814:Larva; D008279:Magnetic Resonance Imaging / Q000379:methods; D010743:Phospholipids; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D013459:Sulfur Hexafluoride; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D005462:Fluorine Radioisotopes; D010743:Phospholipids; D019275:Radiopharmaceuticals; C420843:contrast agent BR1; D019788:Fluorodeoxyglucose F18; D013459:Sulfur Hexafluoride