title: Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: Echinococcosis multilocularis Ulm classification-ultrasound.
abstract: OBJECTIVE
  To establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic alveolar echinococcosis (AE).
  
  
  METHODS
  Clinical data and ultrasonography (US) findings of 185 patients (100 males; 85 females; mean age at diagnosis: 51.4 ± 17.6 years; mean age at time of US examination: 58.7 ± 18.2 years) were retrospectively reviewed with respect to the US morphology of hepatic AE lesions. The sonomorphological findings were grouped according to a five-part classification scheme.
  
  
  RESULTS
  Application of the new classification resulted in the following distribution of sonomorphological patterns among the patients examined: hailstorm (54.1%); pseudocystic (13.5%); ossification (13.0%); hemangioma-like (8.1%); and metastasis-like (6.5%). Only 4.9% of lesions could not be assigned to a sonomorphological pattern.
  
  
  CONCLUSIONS
  The sonomorphological classification proposed in the present study facilitates the diagnosis, interpretation and comparison of hepatic alveolar echinococcosis in routine practice and in the context of scientific studies.
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kratzer
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Beate
authors.initials: B
authors.lastname: Gruener
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Tanja E M
authors.initials: TE
authors.lastname: Kaltenbach
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Sarina
authors.initials: S
authors.lastname: Ansari-Bitzenberger
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Kern
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Fuchs
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Mason
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Thomas F E
authors.initials: TF
authors.lastname: Barth
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Haenle
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Hillenbrand
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Suemeyra
authors.initials: S
authors.lastname: Oeztuerk
authors.affiliation: Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany.
authors.forename: Tilmann
authors.initials: T
authors.lastname: Graeter
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D004444:Echinococcosis, Hepatic / Q000145:classification / Q000000981:diagnostic imaging* / Q000469:parasitology; D048210:Echinococcus multilocularis / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D009626:Terminology as Topic; D018615:Ultrasonography, Doppler, Color
keywords: Alveolar echinococcosis; Classification; Diagnosis; Echinococcus multilocularis; Hepatic echinococcosis; Ultrasonography