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.
ObjectiveTo understand the current situation in the treatment of hepatic echinococcosis.
MethodThe literatures about operation treatment, drug treatment, and the clinical pathway of hepatic echinococcosis were reviewed.
ResultsCurrently, with the continuous development of surgical techniques and the application of minimally invasive surgery, the operative treatments of hepatic echinococcosis had made a great progress, it was still the preferred treatment for the disease. Liver transplantation was made as the final choice. The use of aspiration, sclerotherapy or interventional technique brought a hope for patients intolerant to laparotomy. Moreover, chemotherapy drugs, Chinese herbal medicine, and drug combinations also achieved a very good effect in the treatment of hepatic echinococcosis. The clinical pathway provided a good direction for the treatment of hepatic echinococcosis.
ConclusionFor the treatment of hepatic echinococcosis various, we should choice a reasonable treatment according to the specific circumstances of patients, to achieve the best therapeutic effect with minimal trauma.
ObjectiveTo summarize the clinical features of an adult patient with occult cerebral alveolar echinococcosis with liver and lung infection.
MethodsA Tibetan male patient in his middle age from the epidemic area of echinococcosis infection was diagnosed to have liver, lung and cerebral alveolar echinococcosis infection in Ganzi People's Hospital. He had the resection surgery, and the pathological result confirmed the primary diagnosis. We searched the literatures from January 1985 to December 2015 for occult cerebral alveolar echinococcosis and reviewed all the full texts in China Journal Full-text Database. Seventeen articles were qualified and 42 patients were reported. Combining with the relevant English literature using Medline, we analyzed the epidemic, pathophysiological and clinical manifestations of cerebral alveolar echinococcosis infection and explored the methods of prevention and treatment.
ResultsAccording to the results of literature analysis, cerebral alveolar echinococcosis appeared often secondary to infection of other organs. Nervous system symptom concealed or progressed slowly; imaging and pathological tests were important for diagnosis. Resection surgery was the essential method of cure.
ConclusionAlveolar echinococcosis can affect multiple organs. In patients without neurological symptoms, if other organs are found to be infected, it is important to screen patients with intracranial involvement. Because this kind of patients with intracranial lesions with hydatid are often secondary to other organ infection, active treatment in early phase is necessary in order to avoid further expansion of lesions and metastasis.
ObjectiveTo explore the efficiency of two-stage hepatectomy applicated in complex alveolar echinococcosis. MethodThe clinical data of one case who suffered from complicated alveolar echinococcosis with multiple lesions and then treated with two-stage hepatectomy were analyzed retrospectively. ResultsPreoperative enhanced CT revealed that the hydatid lesion with irregular shape, measuring 14.1 cm×9.2 cm, invaded several segments including left medial lobe and right anterior lobe of liver and the right branch of portal vein and medium hepatic vein were entirely surrounded by it. After preoperative examination surgical exploration was performed, two larger lesions measuring 6 cm×5 cm×4 cm and 5 cm×4 cm×4 cm respectively were found in caudate lobe of liver, three smaller lesions were found in the right and left lobe of liver, among which two measured 2 cm×2 cm×1 cm in the right lobe and one measured 3 cm×2 cm×1 cm in the left lobe. Mesohepatectomy was performed in the first stage, the lesion in left medial lobe and right anterior lobe of liver and the right anterior branch of portal vein were resected during the procedure. The patient recovered well after the operation without complications such as bile leakage or hemorrhage observed. The second stage surgery was performed at three months after operation, the computed tomograph before the surgery revealed that the remained lesions in the right lobe of liver did not proceed obviously and the left lateral external lobe of liver regenerated significantly. In the second stage, the right anterior lobe and part of the right posterior lobe of liver were resected. The patient was discharged on 7 days after operation, and there was no complication and relapse during the 7 months of follow-up period. ConclusionTwo-stage hepatectomy applicated in treating complicated alveolar echinococcosis with multiple lesions is safe and feasible, offering a choice with smaller trauma, lower expense and less complications for patients compared with liver transplantation.
Echinococcosis is a zoonotic disease that seriously threatened human health. The disease is widely distributed in China, including in Tibet Autonomous Region, Qinghai Province, Xinjiang Uygur Autonomous Region, Sichuan Province, and other places, which has become a social and economic burden in China. Human beings are mainly infected with alveolar echinococcosis (AE) and cystic echinococcosis (CE), which mainly involves liver, lung, brain, bone, and other organs or tissues. The surgical resection is the first line treatment, and antiparasitic agents therapy is the main supplementary or salvage treatment method. Currently, classic drugs mainly include albendazole and praziquantel, which use alone or in combination. There are also some attempts to treat echinococcosis, including broad-spectrum anti infective drugs such as nitrozotocin, cell proliferation inhibiting drugs such as bortezomib, metabolic drugs such as metformin, or traditional medicines such as Artemisinin. It was also suggested to adopt a cancer management model for echinococcosis, and the imaging follow-up time for CE after antiparasitic chemotherapy should be at least 3 years, and for AE should be at least 10 years. More importantly, measures such as education and vaccine inoculation should be taken to actively prevent and control the occurrence and spread of echinococcosis.
Hepatic alveolar echinococcosis (HAE) is a severe zoonotic disease caused by Echinococcus multilocularis, primarily affecting the liver. Due to its insidious nature, the patients are often diagnosed at advanced stage, posing significant treatment challenges. We comprehensively examines the progress in surgical techniques for HAE management, focusing on various strategies across different disease stages. For the patients with early-stage HAE, ablation therapy has emerged as an effective treatment option. In the moderate to advanced cases, numerous surgical techniques and innovative approaches have been introduced, including laparoscopic surgery and liver transplantation, with particular emphasis on ex vivo liver resection and autotransplantation. These advancements offer more effective treatment options for the patients with advanced HAE. However, significant challenges persist, notably the preservation of adequate liver function while achieving complete lesion removal. Future research should prioritize the exploration and optimization of existing surgical methods, especially for advanced HAE cases. This includes refining surgical techniques through precise preoperative evaluation and staging, as well as developing novel surgical approaches to enhance safety and efficacy. Furthermore, multicenter and long-term follow-up prospective studies are crucial for validating the effectiveness of new surgical techniques and strategies. Through these concerted efforts, it is anticipated that the survival rates and quality of life for HAE patients will significantly be improved, marking a new era in the management of this complex disease.
ObjectiveTo explore the influencing factors of textbook outcomes (TO) after radical resection for hepatic alveolar echinococcosis (HAE). MethodsClinical data from 427 patients diagnosed with HAE at the Ganzi Branch of West China Hospital, Sichuan University, between 2015 and 2022, were retrospectively collected. The least absolute shrinkage and selection operator regression (LASSO) was first used to screen potential influencing factors for achieving TO (predictive model A). Univariate and multivariate logistic regression analysis were then used to explore the influencing factors of TO (predictive model B). A Nomogram was further constructed and validated. ResultsA total of 427 patients who successfully underwent radical liver resection were included, of which 174 patients (40.7%) achieved TO. Compared to the non-TO group, patients in the TO group had higher proportions of WHO PNM stage of P 1+2 [62.6% (109/174) vs 42.3% (140/253)], N0 [77.0% (134/174) vs 63.6% (161/253)], lesion diameter≤10 cm [77.0% (134/174) vs 64.8% (164/253)], albumin-bilirubin index (ALBI) ≤–2.6 [70.1% (122/174) vs 59.3% (150/253)], and minor liver resection [71.8% (125/174) vs 50.2% (127/253)], higher prealbumin (181 mg/L vs 169 mg/L) and albumin (39 g/L vs 38 g/L) levels, shorter postoperative hospital stay (15 d vs 19 d), and lower hospitalization costs (51 727 RMB vs 62 715 RMB), P<0.05. LASSO regression analysis indicated that P stage, lesion diameter, ALBI, and liver resection method were potential influencing factors for achieving TO after HAE surgery (model A), P<0.05. The TO rate for P 1+2 stage was higher than that of P 3+4 stage, the TO rate for lesion diameter ≤ 10 cm was higher than that of lesion diameter >10 cm, the TO rate for ALBI ≤–2.6 was higher than that of ALBI >–2.6, and the TO rate for minor liver resection was higher than of major liver resection. Multivariate logistic regression analysis showed that P stage (OR=1.800, P=0.025) and liver resection method (OR=1.974, P<0.001) were influencing factors for achieving TO (model B). The TO rates for P1+2 stage and minor liver resection were higher. Predictive model A demonstrated higher accuracy and stability compared to predictive model B (AUC: 0.754 vs 0.712, C-index: 0.756 vs 0.707). ConclusionsAmong patients undergoing radical resection for HAE, less than half achieved TO. Striving to achieve TO can significantly shorten the length of hospital stay and effectively reduce medical costs. The TO predictive model based on P stage, lesion diameter, ALBI, and liver resection method is superior to the model based solely on P stage and liver resection method.
ObjectiveTo assess the value of multi-slice spiral CT (MSCT) in the diagnosis and resectability judgement of hepatic alveolar echinococcosis (HAE).
MethodsThe CT findings of 28 patients who were confirmed HAE by surgical pathological examination were retrospectively analyzed. Comparative analysis were made between the CT findings and surgical pathology.
ResultsAltogether 45 lesions in hepatic were detected. Lesions mainly revealed an infiltrating tumor-like hepatic mass with irregular margins and heterogeneous contents with varied attenuation, including scattered hyper-attenuating calcifications and hypo-attenuating areas corresponding to necrosis, no substantial enhancement, however, the fibro-inflammatory component surrounding the parasitic tissue was enhanced faintly in the delayed phase, and clearly demarcated from surrounding parenchyma. MSCT angiography (CTA) depicted signs of infiltration of hepatic vessels such as pushed, compression, displacement, stenosis, encasement and interruption. Compared with findings of operation, the sensitivity and specificity value of MSCT for evaluating the hepatic artery system disorders were 67%, 97%; and for portal venous system were 83%, 93%; and for hepatic venous system were 84%, 91%; while for inferior vena cava were 85%, 100%. Twelve cases which were evaluated as resectable by MSCT were in accordance with surgical findings. In the rest 16 patients which were judged as non-resectable by MSCT, only 2 patients were radical treatment through partial excision, repair and reconstruction for the involvement of large vessels and bile ducts.
ConclusionMSCT is accuracy in the diagnosis and assessment of vessels complication of HAE. It has an important value to evaluate the resectability of HAE and the planning of treatment.
ObjectiveTo investigate the risk factors affecting severe postoperative complications (Clavien-Dindo classification Ⅲa or higher) in patients with end-stage hepatic alveolar echinococcosis (HAE) underwent ex vivo liver resection and autotransplantation (ELRA), and to develop a nomogram prediction model. MethodsThe clinical data of end-stage HAE patients who underwent ELRA at the West China Hospital of Sichuan University from January 2014 to June 2024 were retrospectively analyzed. The logistic regression was used to analyze the risk factors affecting severe postoperative complications. A nomogram prediction model was established basing on LASSO regression and its efficiency was evaluated using receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis. Simultaneously, a generalized linear model regression was used to explore the preoperative risk factors affecting the total surgery time. Test level was α=0.05. ResultsA total of 132 end-stage HAE patients who underwent ELRA were included. The severe postoperative complications occurred in 47 (35.6%) patients. The multivariate logistic analysis results showed that the patients with invasion of the main trunk of the portal vein or the first branch of the contralateral portal vein (type P2) had a higher risk of severe postoperative complications compared to those with invasion of the first branch of the ipsilateral portal vein (type P1) [odds ratio (OR) and 95% confidence interval (CI)=8.24 (1.53, 44.34), P=0.014], the patients with albumin bilirubin index (ALBI) grade 1 had a lower risk of severe postoperative complications compared to those with grade 2 or higher [OR(95%CI)=0.26(0.08, 0.83), P=0.023]. Additionally, an increased total surgery time or the autologous blood reinfusion was associated with an increased risk of severe postoperative complications [OR(95%CI)=1.01(1.00, 1.01), P=0.009; OR(95%CI)=1.00(1.00, 1.00), P=0.043]. The nomogram prediction model constructed with two risk factors, ALBI grade and total surgery time, selected by LASSO regression, showed a good discrimination for the occurrence of severe complications after ELRA [area under the ROC curve (95%CI) of 0.717 (0.625, 0.808)]. The generalized linear regression model analysis identified the invasion of the portal vein to extent type P2 and more distant contralateral second portal vein branch invasion (type P3), as well as the presence of distant metastasis, as risk factors affecting total surgery time [β (95%CI) for type P2/type P1=110.26 (52.94, 167.58), P<0.001; β (95%CI) for type P3/type P1=109.25 (50.99, 167.52), P<0.001; β (95%CI) for distant metastasis present/absent=61.22 (4.86, 117.58), P=0.035]. ConclusionsFrom the analysis results of this study, for the end-stage HAE patients with portal vein invasion degree type P2, ALBI grade 2 or above, longer total surgery time, and more autologous blood transfusion need to be closely monitored. Preoperative strict evaluation of the first hepatic portal invasion and distant metastasis is necessary to reduce the risk of severe complications after ELRA. The nomogram prediction model constructed based on ABLI grade and total surgery time in this study demonstrates a good predictive performance for severe postoperative complications, which can provide a reference for clinical intervention decision-making.
Objective To evaluate the efficacy and safety of albendazole (ABZ) in the treatment of hepatic cystic echinococcosis (HCE). Methods Randomised trials and quasi-randomised trials of ABZ for treating HCE were sought by electronic and handsearching. Studies were analyzed according to the methods recommended by The Cochrane Collabration. Results Only two studies met the inclusion criteria. The quality of both was graded as B. One study compared ABZ with mebendazole (MBZ). This showed similar effective rates in the numbers of cysts and cases [RR 1.19, 95%CI (0.97, 1.46)] and [RR 1.35, 95%CI (0.91, 2.00)]. The other study compared ABZ plus surgery with surgery alone.This showed that efficacy was comparable between one-month treatment of ABZ plus surgery and surgery alone [RR 1.63, 95%CI (0.90, 2.93)]; but that 3 months of treatment with ABZ plus surgery could significantly improve the efficacy compared to surgery alone [RR 1.89, 95% CI (1.09, 3.29)]. Conclusion In the treatment of HCE, ABZ has similar efficacy on MBZ; long-term (3 months) treatment of ABZ given before surgery may improve the efficacy when compared to surgery alone. More high-quality randomised trials are required to define the role of ABZ in treating HCE.
