Hepatic alveolar echinococcosis and primary liver cancer: differential diagnosis with contrast-enhanced ultrasound_West China Medical Journal

Authors：

YAN Shanling ¹ ,  LU Qiang ² , ZHENG Hong ¹ , LI Cheng ¹

1. Department of Ultrasound, People’s Hospital of Deyang City, Deyang, Sichuan 618000, P. R. China;
2. Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LU Qiang, Email: wsluqiang@126.com

Keywords：

Ultrasound; Contrast agent; Liver cancer; Hepatic alveolar echinococcosis

DOI：

10.7507/1002-0179.201601225

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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.

Citation： YAN Shanling, LU Qiang, ZHENG Hong, LI Cheng. Hepatic alveolar echinococcosis and primary liver cancer: differential diagnosis with contrast-enhanced ultrasound. West China Medical Journal, 2017, 32(7): 1037-1041. doi: 10.7507/1002-0179.201601225 Copy

1.	唐一植, 李倩, 蒋炜. 超声造影对肝泡型包虫病的鉴别诊断价值. 四川医学, 2013, 34(7): 1088-1090.
2.	谭洪亮, 李人立, 宋洁. 肝泡型包虫病肝内外转移及其与肝癌的鉴别诊断. 现代肿瘤医学, 2016(2): 276-278.
3.	路越晴, 邓勇, 张灵强, 等. 泡型肝包虫病的临床治疗进展. 中国普外基础与临床杂志, 2016, 23(5): 547-551.
4.	陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.
5.	卢强, 黄子星, 钟晓绯, 等. 超声造影在肝脏局灶性结节样增生诊断中的应用. 中国普外基础与临床杂志, 2010, 17(4): 403-406.
6.	周如海, 袁瑞, 赵平, 等. 实时超声造影成像在肝脏局灶性病变中的应用研究. 医学影像学杂志, 2010, 20(2): 291-293.
7.	Bosch FX, Ribes J, Cleries R, et al. Epidemiology of hepatocellular carcinoma. Clin Liver Dis, 2005, 9(2): 191-211.
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9.	Claudon M, Dietrich CF, Choi B, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative incooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med, 2013, 34(1): 11-29.
10.	Xu JF, Liu HY, Shi Y, et al. Evaluation of hepatocellular carcinoma by contrast-enhanced sonography correlation with pathologic differentiation. J Ultrasound Med, 2011, 30(5): 625-633.
11.	Jang HJ, Kim TK, Burns PN, et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology, 2007, 244(3): 898-906.
12.	Reuter S, Nussle K, Kolokythas O, et al. Alveolar liver echinococcosis: a comparative study of three imaging techniques. Infection, 2001, 29(3): 119-125.
13.	Ehrhardt AR, Reuter S, Buck AK, et al. Assessment of disease activity in alveolar echinococcosis: a comparison ofcontrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography. Abdom Imaging, 2007, 32(6): 730-736.
14.	杨秉辉, 丛文铭, 周晓军, 等. 原发性肝癌规范化诊治的专家共识. 实用肝脏病杂志, 2009, 12(5): 321-328.
15.	El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 2012, 142(6): 1264-1273.
16.	Harada K, Hirohara J, Ueno Y, et al. Incidence of and risk factors for hepatocellular carcinoma in primary biliary cirrhosis: national data from Japan. Hepatology, 2013, 57(5): 1942-1949.
17.	Kim TK, Jang HJ. Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis. World J Gastroenterol, 2014, 20(13): 3590-3596.
18.	马淑梅, 郑云慧, 樊海宁, 等. 超声造影参数对肝泡型包虫病灶边缘浸润带的分析研究. 中国超声医学杂志, 2016, 32(11): 1001-1003.

1. 唐一植, 李倩, 蒋炜. 超声造影对肝泡型包虫病的鉴别诊断价值. 四川医学, 2013, 34(7): 1088-1090.
2. 谭洪亮, 李人立, 宋洁. 肝泡型包虫病肝内外转移及其与肝癌的鉴别诊断. 现代肿瘤医学, 2016(2): 276-278.
3. 路越晴, 邓勇, 张灵强, 等. 泡型肝包虫病的临床治疗进展. 中国普外基础与临床杂志, 2016, 23(5): 547-551.
4. 陈哲宇. 泡型肝包虫病的外科治疗现状. 中国普外基础与临床杂志, 2016, 23(5): 513-516.
5. 卢强, 黄子星, 钟晓绯, 等. 超声造影在肝脏局灶性结节样增生诊断中的应用. 中国普外基础与临床杂志, 2010, 17(4): 403-406.
6. 周如海, 袁瑞, 赵平, 等. 实时超声造影成像在肝脏局灶性病变中的应用研究. 医学影像学杂志, 2010, 20(2): 291-293.
7. Bosch FX, Ribes J, Cleries R, et al. Epidemiology of hepatocellular carcinoma. Clin Liver Dis, 2005, 9(2): 191-211.
8. Barreiros AP, Piscaglia F, Dietrich CF. Contrast enhanced ultrasound for the diagnosis of hepatocellular carcinoma (HCC): comments on AASLD guidelines. J Hepatol, 2012, 57(4): 930-932.
9. Claudon M, Dietrich CF, Choi B, et al. Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver--update 2012: a WFUMB-EFSUMB initiative incooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultraschall Med, 2013, 34(1): 11-29.
10. Xu JF, Liu HY, Shi Y, et al. Evaluation of hepatocellular carcinoma by contrast-enhanced sonography correlation with pathologic differentiation. J Ultrasound Med, 2011, 30(5): 625-633.
11. Jang HJ, Kim TK, Burns PN, et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology, 2007, 244(3): 898-906.
12. Reuter S, Nussle K, Kolokythas O, et al. Alveolar liver echinococcosis: a comparative study of three imaging techniques. Infection, 2001, 29(3): 119-125.
13. Ehrhardt AR, Reuter S, Buck AK, et al. Assessment of disease activity in alveolar echinococcosis: a comparison ofcontrast enhanced ultrasound, three-phase helical CT and [(18)F] fluorodeoxyglucose positron emission tomography. Abdom Imaging, 2007, 32(6): 730-736.
14. 杨秉辉, 丛文铭, 周晓军, 等. 原发性肝癌规范化诊治的专家共识. 实用肝脏病杂志, 2009, 12(5): 321-328.
15. El-Serag HB. Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 2012, 142(6): 1264-1273.
16. Harada K, Hirohara J, Ueno Y, et al. Incidence of and risk factors for hepatocellular carcinoma in primary biliary cirrhosis: national data from Japan. Hepatology, 2013, 57(5): 1942-1949.
17. Kim TK, Jang HJ. Contrast-enhanced ultrasound in the diagnosis of nodules in liver cirrhosis. World J Gastroenterol, 2014, 20(13): 3590-3596.
18. 马淑梅, 郑云慧, 樊海宁, 等. 超声造影参数对肝泡型包虫病灶边缘浸润带的分析研究. 中国超声医学杂志, 2016, 32(11): 1001-1003.

West China Medical Journal

Hepatic alveolar echinococcosis and primary liver cancer: differential diagnosis with contrast-enhanced ultrasound

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