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European Radiology

, Volume 17, Issue 10, pp 2538–2545 | Cite as

The role of calcification for staging cystic echinococcosis (CE)

  • Waldemar HoschEmail author
  • Marija Stojkovic
  • Thomas Jänisch
  • Günter W. Kauffmann
  • Thomas Junghanss
Hepatobiliary-Pancreas

Abstract

The prevalence of calcified cysts and the significance of calcification as a sign of cyst inactivity in cystic echinococcosis (CE) was evaluated. Seventy-eight patients (36 females, 42 males, mean age 40.8 ± 16.9 years) with CE, having a total of 137 abdominal cysts (116 hepatic, three splenic, one renal and 17 peritoneal cysts), were diagnosed and followed-up by ultrasound during and after albendazole treatment or as part of the watch-and-wait approach recording changes in the cyst wall and content. In 48 patients with 94 cysts, computed tomography (CT) imaging was additionally available and was correlated with ultrasound findings. Cyst wall calcification was classified into (1) “sprinkled”, (2) “eggshell-like”, and (3) “circular”. Calcification of the cyst wall and/or cyst content was detected in 67 echinococcal cysts (48.9% of all cysts) in 39 patients (15 females, 24 males, mean age 40.8 ± 14.8 years). Of the total of 67 calcified cysts, only 23 were compatible with WHO type CE5, 18 with WHO type CE4. Judged by cyst content, the remaining 26 were of WHO type CE1, CE2 and CE3 (n = 1, n = 8, and n = 17, respectively). During a mean period of 34.3 months (±21.3 months) the majority of cysts (n = 32) did not exhibit any change in cyst content and wall properties. Fourteen cysts showed signs of progressive involution, five cysts (all of WHO type CE3) of renewed activity defined by recurring fluid collection. In 16 cysts, no follow-up was available due to surgery or drop out. Calcification of the cyst is not restricted to the inactive WHO cyst types CE4 and CE5, but occurs in all stages and in up to 50% of cysts. The completeness and, most importantly, the stability of consolidation of cyst content over time predicts cyst inactivity more reliably.

Keywords

Cystic echinococcosis Hydatid disease WHO classification Calcification Follow-up 

References

  1. 1.
    Beggs I (1985) The radiology of hydatid disease. AJR Am J Roentgenol 145:639–648PubMedGoogle Scholar
  2. 2.
    Pedrosa I, Saiz A, Arrazola J, Ferreiros J, Pedrosa CS (2000) Hydatid disease: radiologic and pathologic features and complications. Radiographics 20:795–817PubMedGoogle Scholar
  3. 3.
    Caremani M, Benci A, Maestrini R, Rossi G, Menchetti D (1996) Abdominal cystic hydatid disease (CHD): classification of sonographic appearance and response to treatment. J Clin Ultrasound 24:491–500PubMedCrossRefGoogle Scholar
  4. 4.
    Caremani M, Benci A, Maestrini R, Accorsi A, Caremani D, Lapini L (1997) Ultrasound imaging in cystic echinococcosis. Proposal of a new sonographic classification. Acta Trop 67:91–105PubMedCrossRefGoogle Scholar
  5. 5.
    Eckert J, Gemmell M, Meslin F-X, Pawlowski ZS (2001) WHO/OIE manual on echinococcosis in humans and animals: a public health problem of global concern. World Health Organization/World Organization for Animal Health, Paris, pp 20–47Google Scholar
  6. 6.
    Gharbi HA, Hassine W, Brauner MW, Dupuch K (1981) Ultrasound examination of the hydatic liver. Radiology 139:459–463PubMedGoogle Scholar
  7. 7.
    Lewall DB, McCorkell SJ (1985) Hepatic echinococcal cysts: sonographic appearance and classification. Radiology 155:773–775PubMedGoogle Scholar
  8. 8.
    Perdomo R, Alvarez C, Monti J et al (1997) Principles of the surgical approach in human liver cystic echinococcosis. Acta Trop 64:109–122PubMedCrossRefGoogle Scholar
  9. 9.
    World Health Organization (1996) Guidelines for treatment of cystic and alveolar echinococcosis in humans. WHO Informal Working Group on Echinococcosis. Bull World Health Organ 74:231–242Google Scholar
  10. 10.
    Akhan O, Dincer A, Gokoz A et al (1993) Percutaneous treatment of abdominal hydatid cysts with hypertonic saline and alcohol. An experimental study in sheep. Invest Radiol 28:121–127PubMedCrossRefGoogle Scholar
  11. 11.
    World Health Organization Informal Working Group (2003) International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 85:253–261Google Scholar
  12. 12.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Waldemar Hosch
    • 1
    Email author
  • Marija Stojkovic
    • 2
  • Thomas Jänisch
    • 2
    • 3
  • Günter W. Kauffmann
    • 1
  • Thomas Junghanss
    • 2
  1. 1.Department of RadiologyUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Section of Clinical Tropical MedicineUniversity Hospital of HeidelbergHeidelbergGermany
  3. 3.Section of Biostatistics and EpidemiologyUniversity Hospital of HeidelbergHeidelbergGermany

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