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World J Surg Proced. Mar 28, 2014; 4(1): 13-20
Published online Mar 28, 2014. doi: 10.5412/wjsp.v4.i1.13
Diagnostic imaging and interventional procedures in a growing problem: Hepatic alveolar echinococcosis
Mecit Kantarci, Berhan Pirimoglu, Yesim Kizrak
Mecit Kantarci, Berhan Pirimoglu, Yesim Kizrak, Department of Radiology, School of Medicine, Ataturk University, 25090 Erzurum, Turkey
Author contributions: Kantarci M and Pirimoglu B designed the research; Kantarci M, Pirimoglu B and Kizrak Y performed the research; Kantarci M and Kızrak Y analyzed the data; Kantarci M and Pirimoglu B wrote the paper.
Correspondence to: Mecit Kantarci, MD, PhD, Department of Radiology, School of Medicine, Ataturk University, 200 Evler Mah. 14. Sok No 5 Dadaskent, 25090 Erzurum, Turkey.
Telephone: +90-442-2361212 Fax: +90-442-2361301
Received: October 28, 2013
Revised: December 19, 2013
Accepted: February 16, 2014
Published online: March 28, 2014

Alveolar echinococcosis (AE) of the liver is caused by the metacestode of the fox tapeworm Echinococcus multilocularis (E. multilocularis), which is endemic in many parts of the world. AE is a very aggressive and potentially fatal infestation which always affects the liver primarily and metastasizes to any part of the body. Without timely diagnosis and therapy, the prognosis is dismal, with death the eventual outcome in most cases. Diagnosis is usually based on findings at radiological imaging and in serological analyses. The alveolar cysts grow by exogenous proliferation and behave like a malignant neoplasm. Since AE lesions can occur almost anywhere in the body, familiarity with the spectrum of cross-sectional imaging appearances is advantageous. Therefore, AE lesions can cause physicians to generate a long list of differential diagnoses, including malignant tumors. Disseminated parasitic lesions in unusual locations with atypical imaging appearances may make it difficult to narrow the differential diagnosis. For diagnosis, ultrasonography (US) remains the first line examination. For a more accurate disease evaluation, aiming to guide the surgical strategy, computed tomography (CT), magnetic resonance imaging (MRI), including magnetic resonance cholangiography (MRC) imaging, are of importance, providing useful complementary information. However, making the correct diagnosis is possible if imaging findings are correlated with appropriate clinical findings. We present an overview of the radiological patterns produced by E. multilocularis lesions as seen on US, CT and MRI and discuss the interventional procedures in hepatic AE lesions.

Keywords: Alveolar echinococcosis, Liver, Diagnosis, Intervention, Imaging, Review

Core tip: Diagnosis and treatment of alveolar echinococcosis remains a challenge for clinicians. Most patients suffering from a chronic carrier status need continuous medical treatment and follow-up examinations. Diagnosis of alveolar echinococcosis is supported by results from imaging studies, histopathology and/or serological analyses. The present review summarizes current understanding of imaging features and knowledge of interventional procedures.