Differentiation of hepatic alveolar echinococcosis with a hemangioma-like pattern compared to typical liver hemangioma using contrast-enhanced ultrasound: a pilot study

• Published in: Infection Vol. 51; no. 1; pp. 159 - 168
• Main Authors: Philipp, Jana, Schmidberger, Julian, Schlingeloff, Patrycja, Kratzer, Wolfgang
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2023; Springer Nature B.V
• Subjects: Adult; Aged; Alveoli; Contrast Media; Diaphragm; Differential diagnosis; Differentiation; Echinococcosis; Echinococcosis, Hepatic - diagnostic imaging; Echinococcosis, Hepatic - pathology; Echinococcus multilocularis; Family Medicine; Female; females; General Practice; Hemangioma; Hemangioma - diagnostic imaging; Hemangioma - pathology; Humans; infection; Infectious Diseases; intermediate hosts; Internal Medicine; Lesions; Liver; Liver cancer; Liver Neoplasms - diagnostic imaging; Male; males; Medicine; Medicine & Public Health; Middle Aged; Original Paper; Parasitic diseases; Patients; Pilot Projects; Prospective Studies; Retrospective Studies; Ultrasonic imaging; Ultrasonic testing; ultrasonics; Ultrasonography; Ultrasound; Alveolar echinococcosis; Contrast-enhanced ultrasound; EMUC-US; Ultrasonography; Hepatic hemangioma; Echinococcus multilocularis
• ISSN: 0300-8126; 1439-0973; 1439-0973
• DOI: 10.1007/s15010-022-01866-z

Purpose Echinococcus multilocularis infects humans as a false intermediate host, primarily with intrahepatic manifestation. Incorrect diagnostic interpretation of these liver tumors, especially the hemangioma-like pattern, can lead to progressive disease. The aim of the study was to investigate the differentiation of typical hemangioma and a hemangioma-like pattern of E. multilocularis using contrast-enhanced ultrasound (CEUS). Methods This prospective clinical pilot study comprised patients with hemangioma ( n  = 14) and patients with alveolar echinococcosis (AE) and hemangioma-like pattern ( n  = 7). Inclusion criteria were the detection of a liver lesion according to a hemangioma-like pattern on E. multilocularis Ulm classification—ultrasound (EMUC-US) and “confirmed” or “probable” AE according to WHO case definition. The comparison group had hepatic hemangioma with typical B-scan sonographic morphology. All participants underwent conventional and contrast-enhanced ultrasonography. Results The patient group comprised five men (71.4%) and two women (28.6%) with a mean average age of 64.1 ± 11.2 years. The patient group with hemangioma comprised nine female subjects (64.3%) and five male subjects (35.7%) with a mean average age of 56.1 ± 12.0 years. Early arterial bulbous ring enhancement ( p  < 0.0001) and iris diaphragm phenomenon could only be visualized in the patients with hemangioma ( p  < 0.0001). Furthermore, the patients with hemangioma exhibited hyperenhancement in the late phase ( p  = 0.0003). In contrast, the patients exhibited typical early arterial rim enhancement ( p  < 0.0001) and, in the portal venous and late phase, complete or incomplete non-enhancement (black hole sign; p  = 0.0004). Conslusion The behavior of hemangioma-like AE lesions and typical liver hemangiomas is significantly different on CEUS. AE should be considered as a possible differential diagnosis, especially in high-endemic areas.