Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 21, 2015; 21(43): 12392-12402
Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12392
Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: Echinococcosis multilocularis Ulm classification-ultrasound
Wolfgang Kratzer, Beate Gruener, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Peter Kern, Michael Fuchs, Richard A Mason, Thomas FE Barth, Mark M Haenle, Andreas Hillenbrand, Suemeyra Oeztuerk, Tilmann Graeter
Wolfgang Kratzer, Tanja EM Kaltenbach, Sarina Ansari-Bitzenberger, Mark M Haenle, Suemeyra Oeztuerk, Department of Internal Medicine I, University Hospital Ulm, 89081 Ulm, Germany
Beate Gruener, Comprehensive Infectious Diseases Center (CIDC) Ulm, 89081 Ulm, Germany
Peter Kern, Comprehensive Infectious Diseases Center, University Hospital Ulm, D-89081 Ulm, Germany
Michael Fuchs, Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA 23298, United States
Richard A Mason, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH 44106, United States
Thomas FE Barth, Institute of Pathology, University Hospital Ulm, 89081 Ulm, Germany
Andreas Hillenbrand, Department of General- and Visceral Surgery, University Hospital Ulm, 89081 Ulm, Germany
Tilmann Graeter, Department of Interventional and Diagnostic Radiology, University Hospital Ulm, 89081 Ulm, Germany
Author contributions: Kratzer W and Gruener B contributed equally to this work; Kratzer W, Gruener B and Graeter T designed the research; Gruener B, Kaltenbach TEM and Ansari-Bitzenberger S performed the research; Oeztuerk S, Mason RA, Haenle MM, Barth TFE, Kern P, Fuchs M and Hillenbrand A analyzed the data; and Kratzer W, Gruener B and Kaltenbach TEM wrote the paper.
Institutional review board statement: The study was reviewed and approved by the local Ethics Committee of University of Ulm.
Informed consent statement: Because of retrospective and anonymous character of this study the need for informed consent was waived by the Institutional Review Board.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Wolfgang Kratzer, MD, Professor, Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Telephone: +49-731-50044730 Fax: +49-731-50044620
Received: April 13, 2015
Peer-review started: April 15, 2015
First decision: June 2, 2015
Revised: June 19, 2015
Accepted: September 13, 2015
Article in press: September 14, 2015
Published online: November 21, 2015

AIM: 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.

CONCLUSION: 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.

Keywords: Hepatic echinococcosis, Echinococcus multilocularis, Classification, Diagnosis, Ultrasonography, Alveolar echinococcosis

Core tip: Alveolar echinococcosis (AE) is a rare but potentially life-threatening parasitic disease. Despite the importance of ultrasonography as an imaging modality in the work-up of hepatic AE, there is no established sonomorphological classification of hepatic AE lesions analogous to the World Health Organization’s ultrasonographic classification for cystic echinococcosis. Objective of the present study was to establish an ultrasonographic classification based on a large sample of patients with confirmed hepatic AE. Assignment of hepatic AE lesions to one of the five sonomorphological patterns was successful in 95% of cases based on the ultrasonographic classification scheme proposed in the present study.