Published online Apr 7, 2016. doi: 10.3748/wjg.v22.i13.3621
Peer-review started: September 23, 2015
First decision: October 15, 2015
Revised: October 30, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: April 7, 2016
AIM: To establish a computed tomography (CT)-morphological classification for hepatic alveolar echinococcosis was the aim of the study.
METHODS: The CT morphology of hepatic lesions in 228 patients with confirmed alveolar echinococcosis (AE) drawn from the Echinococcus Databank of the University Hospital of Ulm was reviewed retrospectively. For this reason, CT datasets of combined positron emission tomography (PET)-CT examinations were evaluated. The diagnosis of AE was made in patients with unequivocal seropositivity; positive histological findings following diagnostic puncture or partial resection of the liver; and/or findings typical for AE at either ultrasonography, CT, magnetic resonance imaging or PET-CT. The CT-morphological findings were grouped into the new classification scheme.
RESULTS: Within the classification a lesion was dedicated to one out of five “primary morphologies” as well as to one out of six “patterns of calcification”. “primary morphology” and “pattern of calcification” are primarily focussed on separately from each other and combined, whereas the “primary morphology” V is not further characterized by a “pattern of calcification”. Based on the five primary morphologies, further descriptive sub-criteria were appended to types I-III. An analysis of the calcification pattern in relation to the primary morphology revealed the exclusive association of the central calcification with type IV primary morphology. Similarly, certain calcification patterns exhibited a clear predominance for other primary morphologies, which underscores the delimitation of the individual primary morphological types from each other. These relationships in terms of calcification patterns extend into the primary morphological sub-criteria, demonstrating the clear subordination of those criteria.
CONCLUSION: The proposed CT-morphological classification (EMUC-CT) is intended to facilitate the recognition and interpretation of lesions in hepatic alveolar echinococcosis. This could help to interpret different clinical courses better and shall assist in the context of scientific studies to improve the comparability of CT findings.
Core tip: Computed tomography (CT), mostly combined with positron emission tomography, provides one of the most important diagnostic tools in suspected alveolar echinococcosis. Aim of the study was to establish a new CT-classification based on a large patient collective with confirmed hepatic alveolar echinococcosis. The Echinococcosis Multilocularis Ulm Classification-CT presented in this paper is intended to facilitate the recognition and interpretation of hepatic lesions in alveolar echinococcosis based on CT-morphological criteria. It can also be used to more objectively interpret different clinical courses and enhance the comparability of CT findings in the context of scientific studies.