title: How to not miss alveolar echinococcosis in hepatic lesions suspicious for cholangiocellular carcinoma.
abstract: OBJECTIVE
  Hepatic alveolar echinococcosis (AE) resembles intrahepatic cholangiocarcinoma (ICC) on radiological imaging. The purpose of this study was to identify criteria to discriminate AE from ICC with CT and MR Imaging.
  
  
  METHODS
  One hundred and sixteen imaging studies of 94 patients (CT n = 65; MRI n = 51) diagnosed with AE (n = 55) or ICC (n = 39) were retrospectively reviewed by two blinded radiologists for lesion features including enhancement pattern and matrix composition. A consensus read was conducted in cases of disagreement. Uni- and multivariate logistic regression with bootstrapping were used for analysis.
  
  
  RESULTS
  Using CT, no or septal enhancement and calcification yielded the highest values of sensitivity/specificity (90.9%/90.6% and 81.8%/96.9%) for AE. Using MRI, no or septal enhancement and cystic components achieved the highest sensitivity/specificity (90.9%/100.0% and 84.8%/66.7%) for AE. Multivariate logistic regression identified the following strong independent predictors for AE: for MRI, no or septal enhancement (odds ratio [OR] 322.4; p < 0.001); for CT, no or septal enhancement and calcification (OR 35.9 and 42.5; p < 0.001 and p < 0.01, respectively). No or septal enhancement and calcification demonstrated the highest interreader agreement (>90%).
  
  
  CONCLUSIONS
  Enhancement characteristics and matrix calcifications offer the strongest discriminating potential between AE and ICC with a high sensitivity, specificity, and interreader agreement.
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. jan.mueller84@googlemail.com.
authors: J
authors: J
authors: Mueller
authors: Department of Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
authors: M
authors: M
authors: Stojkovic
authors: National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
authors: A K
authors: AK
authors: Berger
authors: Department of Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
authors: K D
authors: KD
authors: Rosenberger
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors: C L
authors: CL
authors: Schlett
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors: H-U
authors: HU
authors: Kauczor
authors: Department of Infectious Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany.
authors: T
authors: T
authors: Junghanss
authors: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors: T F
authors: TF
authors: Weber
mesh_terms: D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging*; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D004444:Echinococcosis, Hepatic / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
keywords: Alveolar echinococcosis; Calcification; Cholangiocarcinoma; Computed tomography; Enhancement; Magnetic resonance imaging