Imaging analysis of 79 cases of hepatic echinococcosis

Abstract

Objective To analyze the imaging manifestations of 79 cases of hepatic echinococcosis retrospectively, so as to provide evidences for improving the diagnosis and differential diagnosis of the disease.

Methods Seventy-nine patients with hepatic echinococcosis who underwent imaging examinations and pathologic confirmation in Qinghai Provincial People’s Hospital from 2014 to 2017 were chosen as the investigation objects, and the data of their medical records and imaging manifestations were collected and analyzed.

Results Among the 79 cases of hepatic echinococcosis, 57 were suffered from cystic echinococcosis (CE) and 22 were suffered from alveolar echinococcosis (AE) . Among the patients with CE, those in single cystic type, multiple cysts type, internal capsule collapse type, solid type, and calcification type were 21, 16, 9, 4 cases and 7 cases respectively. The imaging signs of 62 cases were common. The image of the single cystic type was characterized by intrahepatic cystic water-like lesions, the cystic wall was thin and uniform without any enhancement. The multiple cysts were characterized by "cyst in the cyst", "rose petals", and "spoke wheel". The collapse and separation of the internal capsule was manifested as "drift belt sign" and "double ring sign", the calcification of the cyst wall was curved and eggshell-shaped, the contents of the cyst were cotton-shaped or the whole lesion was calcific. The image of the patients with AE was manifested as a solid mass in the liver, the density and signal were heterogeneous, the edge was irregular and not obviously enhanced, the "small vesicles" scattered in the lesion were often accompanied by calcification, and the whole lesion showed a map appearance. The other 17 cases of hepatic echinococcosis showed complex and rare imaging features. The capsules of 6 cases of CE contained fat, the images presented single or multiple fat density nodules in the hepatic hydatid cyst, and CT value was –28 to –84 HU; in 4 cases of echinococcosis, the lesions were broken into the bile duct, the density of adjacent bile duct was increased, with bile duct wall thickening and peripheral biliary dilatation. For the 4 cases of echinococcosis combined with primary liver cancer, the imaging manifestations of the hepatic cysts presented solid-mass enhancement, with "fast forward and fast out" performance. For the image of the 3 cases of CE with infection, the cystic wall was thickening and enhanced obviously, of these, 2 cases had gaseous shadows in the cyst, 1 patient’s cyst was complicated with infection and it invaded the abdominal wall.

Conclusion The imaging manifestations of hepatic echinococcosis are varied and complicated, which need careful analysis for differential diagnosis.

Abstract

[ 摘要] 目的 回顾性分析 79 例肝棘球蚴病患者的影像学表现, 为该病诊断与鉴别诊断提供参考。 方法 收集 2014–2017年在青海省人民医院行影像学检查并经病理检查证实的 79 例肝棘球蚴病患者病历资料, 对其影像学表现进行回顾 性分析。 结果  79 例肝棘球蚴病患者中, 细粒棘球蚴病 57例, 多房棘球蚴病 22例; 细粒棘球蚴病患者中, 单囊型 21例, 多子囊型 16 例, 内囊塌陷型 9 例, 实变型 4例, 钙化型 7例。 79 例患者中, 62例为常见影像学征象。单囊型细粒棘球蚴病 表现为肝内囊性水样病灶, 囊壁薄厚均匀、无强化; 多子囊型表现为“囊中囊”、“玫瑰花瓣”、“轮辐征”等; 当内囊塌陷分离 时表现为“飘带征”、“双环征”等征象; 囊壁钙化时呈弧线状、蛋壳状, 囊内容物呈现絮状或者整个病灶钙化。多房棘球蚴 病表现为肝内实性肿块, 密度及信号不均匀, 边缘不规则; 病灶强化不明显, 病灶内散在或者群簇状分布的“小囊泡”, 常 伴有钙化, 整个病灶呈“地图样”外观。另外 17例患者表现为复杂少见的影像征象; 其中 6 例细粒棘球蚴病囊内含脂肪, 影像表现为囊内单发或多发脂肪密度结节灶, CT值为–28～–84 HU; 4例病灶破入胆管, 邻近胆管密度增高, 胆管壁增 厚, 周围胆管扩张; 4例合并原发性肝癌, 影像表现为肝内细粒或多房棘球蚴病合并实性强化肿块, 增强呈“快进快出”表 现; 3例合并感染, 影像学表现为囊壁明显增厚且强化明显, 其中 2例囊内见气体影, 1例囊肿合并感染并侵及腹壁。 结 论肝棘球蚴病影像学表现复杂多样, 在临床工作中需认真分析, 做好鉴别诊断。