• Echinococcus multilocularis
• alveolar echinococcosis
• diagnostic techniques
• parasite

• 2017YFA0205201 the Major State Basic Research Development Program of China
• 81925019 the National Natural Science Foundation of China
• U1705281 the National Natural Science Foundation of China
• 20720190088 the Fundamental Research Funds for the Central Universities
• 20720200019 the Fundamental Research Funds for the Central Universities
• 2020Y4003 the Science Foundation of Fujian Province
• 201812631010 the Science Foundation of Fujian Province
• NCET-13-0502 the Program for New Century Excellent Talents in University, China
• GZC20231414 the Postdoctoral Fellowship Program of CPSF

• children
• contrast-enhanced ultrasound
• diagnosis
• hepatic echinococcosis
• hepatoblastoma
• pediatrics
• ultrasound

• Humans
• Male
• Middle Aged
• Diagnosis, Differential
• Echinococcosis, Hepatic/diagnosis
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcosis, Hepatic/surgery
• Germany
• Echinococcosis/diagnosis
• Echinococcosis/diagnostic imaging
• Hepatectomy
• Europe

Echinococcosis is a zoonotic disease caused by parasites belonging to the genus Echinococcus that primarily affect the liver. The western plateau and pastoral areas of China are high-risk regions for hepatic cystic echinococcosis and hepatic alveolar echinococcosis (HAE). The high late mortality rate associated with HAE underscores the critical need for early diagnosis to improve cure rates and mitigate the disease burden in endemic areas. Currently, the World Health Organization recommends ultrasonography as the preferred initial screening method for hepatic echinococcosis. However, distinguishing between specific types of lesions, such as those of hepatic cystic echinococcosis and HAE, and other focal liver lesions is challenging. To address this issue, contrast-enhanced ultrasound is recommended as a tool to differentiate solid and cysto-solid hepatic echinococcosis from other focal liver lesions, significantly enhancing diagnostic accuracy. In this comprehensive review, we discuss the progression of hepatic echinococcosis and detail the imaging features of various types of echinococcosis using conventional, contrast-enhanced, and intraoperative ultrasound techniques. Our objective is to provide robust imaging evidence and guidance for early diagnosis, clinical decision making, and postoperative follow-up in regions with high disease prevalence.

• Echinococcosis
• Zoonotic disease
• Ultrasound
• Contrast-enhanced ultrasound
• Diagnosis

• Classification
• Hepatic echinococcosis
• PET/CT
• Semi-quantitative parameters

• Humans
• Fluorodeoxyglucose F18
• Positron Emission Tomography Computed Tomography/methods
• Male
• Echinococcosis, Hepatic/diagnostic imaging
• Female
• Adult
• Middle Aged
• Radiopharmaceuticals
• Tibet
• Aged
• Young Adult
• ROC Curve
• Retrospective Studies
• Sensitivity and Specificity

• National Natural Science Foundation of China

• calcification
• cavitary
• cystic
• hepatic masses
• mineralization

• Dogs
• Animals
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcosis, Hepatic/veterinary
• Echinococcosis, Hepatic/pathology
• Retrospective Studies
• Echinococcosis/veterinary
• Tomography, X-Ray Computed/veterinary
• Dog Diseases/diagnostic imaging
• Dog Diseases/pathology

• Humans
• Echinococcosis/diagnostic imaging
• Echinococcosis/drug therapy
• Europe
• Radiologists

• Alveolar echinococcosis
• Case report
• Misdiagnosis
• Ultrasound

• chronic liver disease
• clinical decision making
• liver
• liver imaging

• Humans
• Echinococcosis, Hepatic/complications
• Echinococcosis, Hepatic/diagnosis
• Retrospective Studies
• Constriction, Pathologic/complications
• Quality of Life

• Alveolar echinococcosis
• Contrast-enhanced ultrasound
• Conventional ultrasound
• Cystic echinococcosis
• Differentiation
• Hepatic echinococcosis

• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission
• 2021WZK1002 Open Project of Key Laboratory for Research on Prevention and Control of Echinococcosis of National Health Commission

• Alveolar echinococcosis
• Contrast-enhanced ultrasound
• EMUC-US
• Echinococcus multilocularis
• Hepatic hemangioma
• Ultrasonography

• Alveolar echinococcosis
• Cancer
• Echinococcus multilocularis
• HIV
• Immunosuppressive therapy
• Malignant haemopathy
• Primary immune deficiency
• Transplantation

This study aims to investigate the ultrasonographic characteristics of early hepatic alveolar echinococcosis (HAE) and improve the qualitative diagnostic ability of sonographers.

The data of 80 positive cases of HAE screened and diagnosed by ultrasonography and serum immunology (33 males and 44 females with a mean age of 44.12 ± 14.31 y) were used in the study. The imaging characteristics of the lesions (i.e., intrahepatic distribution, shape, size, echo, blood flow, and growth characteristics) were analyzed retrospectively, and the ultrasonographic characteristics of early lesions were discussed in combination with their basic pathological changes.

Patients with lesions of the proliferative infiltration type accounted for 57.5% (46/80), the fibrous calcification type accounted for 26.25% (21/80), the necrotic liquefaction type accounted for 6.25% (5/80), and the mixed type accounted for 10% (8/80). Patients with lesions involving the right lobe and the left lobe accounted for 76.25% (61/80) and 11.25% (9/80), respectively, and with lesions involving both the left and right lobes accounted for 12.5% (10/80). There were statistically significant differences in diameter between all types of lesions (n = 88; F = 5.926 and P = 0.004). Focal hyperechoic and diffuse heterogenous nodular changes were the main manifestations of early proliferative infiltration lesions.

Ultrasonography is extremely valuable in the diagnosis of early HAE. Capillary hemangioma-like changes and hailstorm sign are the main characteristics of early lesions of HAE, and calcification is a common concomitant sign.

We read the article titled, “Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification,” by Schuhbaur J with great interest. However, we found some worthwhile issues that we believe should be discussed with the authors, and have provided our comments in this letter. It would be valuable if the authors could provide further information about the clinical stages, follow-up time, and clinical outcomes of the patients.

• Alveolar echinococcosis
• Albendazole
• Surgical treatment
• Ultrasound
• Follow-up

• Albendazole/therapeutic use
• Echinococcosis/drug therapy
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcosis, Hepatic/surgery
• Follow-Up Studies
• Humans

• Contrast-Enhanced Ultrasound (CEUS)
• Diagnostic
• Hepatic Alveolar Echinococcosis (HAE)
• Liver
• Ultrasonography (US)

Background: Alveolar echinococcosis (AE) is a potentially lethal parasitosis with a broad spectrum of disease dynamics in affected patients. To guide clinical management, we assessed initial prognostic factors for both progressive and controlled AE based on initial staging. Methods: A retrospective cohort study was conducted, examining 279 patients assigned to different clinical groups: cured, stable with and without the need for benzimidazole treatment, and progressive disease. Univariate analysis compared demographic and clinical variables. Significant variables were subsequently entered into two separate logistic regression models for progressive and controlled disease. Results: Based on the multivariate analysis, a large AE lesion (OR = 1.02 per millimetre in size; 95%CI 1.004–1.029), PNM staging (OR = 2.86; 95%CI 1.384–5.911) and especially the involvement of neighbouring organs (OR = 3.70; 95%CI 1.173–11.653) remained significant risk factors for progressive disease. A negative Em2+ IgG (OR = 0.25; 95%CI 0.072–0.835) and a small AE lesion (OR = 0.97; 95%CI 0.949–0.996) were significant protective factors. Conclusions: Patients with large lesions and advanced stages should be monitored closely and most likely require long-term treatment with benzimidazoles if curative resection is not feasible. Patients with small lesions and negative Em2+ IgG seem able to control the disease to a certain extent and a less strict treatment regimen might suffice.

• Cysts
• Echinococcosis/diagnostic imaging
• Echinococcosis, Hepatic/diagnostic imaging
• Humans

• FDG-PET
• MRI
• PET/MR
• alveolar echinococcosis
• liver imaging

• CT
• MRI
• US
• alveolar echinococcosis
• imaging

Human alveolar echinococcosis (AE), which is caused by the cestode Echinococcus (E.) multilocularis, is an epidemiologically relevant issue in modern medicine and still poses a diagnostic and therapeutic challenge. Since diagnosis mainly relies on imaging procedures and serological testing, we retrospectively and comparatively analyzed the performance of an Echinococcus IgG screening ELISA, whole serum IgE, and two specific confirmatory ELISA platforms using the defined E. multilocularis antigens Em2-Em18 (Em2+) and recombinant Em18 (recEm18). With special emphasis on the clinical usefulness of recEm18, we correlated the laboratory results with clinical characteristics and imaging findings in a large and well-characterized cohort of N = 124 AE patients, who were followed over several years after either surgical plus subsequent pharmacological treatment or pharmacotherapy alone. All patients had routinely received PET-CTI every two years. Our data reveal strong correlations for both Echinococcus IgG and recEm18 with tracer uptake in PET-CTI and parasitic lesion size and number, suggesting additional clinical usefulness of recEm18 for certain constellations only, while IgG and Em2+ still appear reasonable and sensitive screening methods for initial diagnosis of AE. With this study, we aim to contribute to further optimizing medical care of AE patients. For instance, it might be reasonable to consider the replacement of some PET-CTI follow-ups by imaging procedures with less radiation exposure or serological means alone. Further studies that clarify the correlation of serological markers with ultrasound criteria might be particularly useful, and further retrospective as well as prospective investigations are justified in this context.

• Benzimidazoles
• Echinococcus
• Genome
• Imaging
• Praziquantel
• Taenia
• Taeniid cestode
• Transmission dynamics, vaccine and control

When Echinococcus multilocularis infects humans as a false intermediate host, alveolar echinococcosis (AE) usually manifests primarily intrahepatically and is initially asymptomatic. If the disease remains undiagnosed and untreated, progressive growth occurs, reminiscent of malignant tumours. The only curative therapy is complete resection, which is limited to localised stages, and palliative drug therapy is used otherwise. Consequently, early diagnosis and reliable detection of AE lesions are important. For this reason, abdominal ultrasonography, as the most common primary imaging for AE, relies on classification systems.

To investigate how hepatic AE lesion sonomorphology changes over time in the Echinococcosis Multilocularis Ulm Classification (EMUC)-ultrasound (US) classification.

Based on data from Germany’s national echinococcosis database, we evaluated clinical and US imaging data for 59 patients according to the AE case definition in our preliminary retrospective longitudinal study. There had to be at least two liver sonographies ≥ 6 mo apart, ≥ 1 hepatic AE lesion, and complete documentation in all US examinations. The minimum interval between two separately evaluated US examinations was 4 wk. The AE reference lesion was the largest hepatic AE lesion at the time of the first US examination. To classify the sonomorphologic pattern, we used EMUC-US. In addition to classifying the findings of the original US examiner, all reference lesions at each examination time point were assigned EMUC-US patterns in a blinded fashion by two investigators experienced in US diagnosis. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, United Stated). P values < 0.05 were considered statistically significant.

The preliminary study included 59 patients, 38 (64.5%) women and 21 (35.6%) men. The mean age at initial diagnosis was 59.9 ± 16.9 years. At the time of initial ultrasonography, a hailstorm pattern was present in 42.4% (25/59) of cases, a hemangioma-like pattern in 16.9% (10/59), a pseudocystic pattern in 15.3% (9/59), and a metastasis-like pattern in 25.4% (15/59). For the hailstorm pattern, the average lesion size was 67.4 ± 26.3 mm. The average lesion size was 113.7 ± 40.8 mm with the pseudocystic pattern and 83.5 ± 27.3 mm with the hemangioma-like pattern. An average lesion size of 21.7 ± 11.0 mm was determined for the metastasis-like pattern. Although the sonomorphologic pattern remained unchanged in 84.7% (50/59) of AE reference lesions, 15.3% (9/59) showed a change over time. A change in pattern was seen exclusively for AE lesions initially classified as hemangioma-like or pseudocystic. A total of 70% (7/10) of AE lesions initially classified as hemangioma-like showed a relevant change in pattern over time, and 85.7% (6/7) of these were secondarily classified as having a hailstorm pattern, with the remainder (1/7; 14.3%) classified as having a pseudocystic pattern. A total of 22.2% (2/9) of AE lesions initially classified as pseudocystic showed a relevant change in pattern over time and were classified as having a hailstorm pattern. For AE lesions initially classified as having a hailstorm or metastatic pattern, no pattern change was evident. All patients with pattern change were on continuous drug therapy with albendazole.

The sonomorphology of hepatic AE lesions may change over time. The hemangioma-like and pseudocystic patterns are affected.

• Alveolar echinococcosis
• Echinococcus multilocularis
• Ultrasonography
• Sonomorphology
• Pattern change

• Animals
• Echinococcosis
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcus multilocularis
• Female
• Follow-Up Studies
• Humans
• Liver/diagnostic imaging
• Longitudinal Studies
• Male
• Retrospective Studies
• Ultrasonography

Objective: To propose a modification of the Kodama classification to classify type III lesions of alveolar echinococcosis (AE) that do not have microcysts. Materials and Methods: 200 magnetic resonance imaging (MRI) images of AE liver lesions from four endemic regions of the world were classified according to Kodama, distinguishing within type III those with microcysts from those without. Each center included 50 MRIs of patients with unoperated AA liver lesions. The first 50 cases were classified by a first reader in the presence of four second-line readers from each region. Then each second-line reader classified his or her 50 cases. Results: In all centers, type III lesions were predominant: 58% of the total lesions and 23% of them were without microcysts. The average age of the patients was 47 years. In China, the patients were on average younger and the lesions larger. German patients had more lesions within the liver. Type I and II lesions, synonymous with earlier diagnosis, were more common in Europe. Conclusion: The Kodama classification needed to be modified because of the existence of a significant proportion of unclassifiable lesions. This is especially true since the presence of microcysts is an informative element of parasite activity. Therefore, this study proposes a Kodama-XUUB classification with type IIIa lesions having microcysts and type IIIb lesions not having microcysts.

• Alveolar echinococcosis
• Kodama classification
• Magnetic resonance imaging
• XUUB study

• Echinococcosis
• Epidemiological characteristics
• Field survey
• Risk assessment
• Shiqu county

• Alveolar echinococcosis
• Contrast-enhanced ultrasound
• Metacestode activity
• Positron-emission tomography

Alveolar echinococcosis (AE) lesion microenvironment (LME) is crucial site where parasite-host interactions happen and of great significance during surgery and obtaining liver samples for basic research. However, little is known about quantification of LME range and its’ metabolic activity regarding different lesion characteristics.

A prospective and retrospective analysis of LME from surgical AE patients was performed. Patients (n = 75) received abdominal computed tomography (CT) and position emission tomography/computed tomography using ¹⁸F-fluodeoxyglucose (¹⁸F-FDG-PET/CT) within 1 week prior to surgery. Semiquantitatively, calcification was clustered with 0%, < 50% and ≥ 50% degrees at lesion periphery; liquefaction was clustered with 0%, < 50%, 50 ~ 75%, ≥75% degrees at lesion center using volumetric ratio. Tumor to background ratio (TBR) of ¹⁸F-FDG standard uptake value (SUV, n = 75) was calculated, and range of ¹⁸F-FDG uptake area was measured; Multi-site sampling method (MSS, n = 35) was introduced to obtain histological slides to evaluate immune cell infiltrative ranges.

Altogether six major lesion groups have been identified (A: 0% calcified, 0% liquefied; B: ≥50% calcified, 0% liquefied; C: < 50% calcified, < 50% liquefied; D: ≥50% calcified, < 50% liquefied; E: < 50% calcified, 50 ~ 75% liquefied; F: ≥50% calcified, ≥75% liquefied). Statistically, TBR values respectively were 5.1 ± 1.9, 2.7 ± 1.2, 4.2 ± 1.2, 2.7 ± 0.7, 4.6 ± 1.2, 2.9 ± 1.1 in groups A ~ F, and comparisons showed A > B, A > D, A > F, E > B, E > D, E > F, C > B, C > D, C > F (P < 0.05); LME ranges indicated by PET/CT respectively were 14.9 ± 3.9, 10.6 ± 1.5, 12.3 ± 1.1, 7.8 ± 1.6, 11.1 ± 2.3, 7.0 ± 0.4 mm in groups A ~ F, and comparisons showed A > B, A > D, A > F, A > E, C > B, C > D, C > F, E > D, E > F, B > D, B > F (P < 0.05); LME ranges indicated by MSS respectively were 17.9 ± 4.9, 13.0 ± 2.7, 11.9 ± 2.6, 6.0 ± 2.2, 11.0 ± 4.1, 6.0 ± 2.2 mm in groups A ~ F, and comparisons showed A > C, A > D, A > F, B > D, B > F, C > D, C > F (P < 0.05). Generally, less calcifications indicated higher TBR values and wider LME ranges; and, severer liquefactions indicated smaller LME ranges. Additionally, patients with previous medication history had lower TBR values.

PET/CT and MSS method showed distinct TBRs and LME ranges for different calcifications and liquefactions. This study would be able to provide references for both surgical resections of lesions and more accurate sample acquisitions for basic research targeted to immunology.

The online version contains supplementary material available at 10.1186/s12879-021-06366-3.

• Alveolar echinococcosis (AE)
• Immune infiltration
• Lesion microenvironment (LME)
• Multi-site sampling (MSS)
• PET/CT

• Echinococcus granulosus
• Echinococcus multilocularis
• Liver parasites
• alveolar echinococcosis
• amoebiasis
• ascariasis
• cystic echinococcosis
• fascioliasis
• hydatid disease
• liver flukes
• schistosomiasis

• alveolar echinococcosis
• clinical management
• incubation period
• risk factors

Human alveolar echinococcosis (AE) caused by Echinococcus multilocularis is an underreported, often misdiagnosed and mistreated parasitic disease mainly due to its low incidence. The aim of this study was to describe the epidemiological and clinical characteristics of human AE patients in Hungary for the first time.

Between 2003 and 2018, epidemiological and clinical data of suspected AE patients were collected retrospectively from health database management systems.

This case series included a total of 16 AE patients. The mean age of patients was 53 years (range: 24–78 years). The sex ratio was 1:1. Four patients (25%) revealed no recurrence after radical surgery and adjuvant albendazole (ABZ) therapy. For five patients (31.3%) with unresectable lesions, a stabilization of lesions with ABZ treatment was achieved. In seven patients (43.8%), progression of AE was documented. The mean diagnostic delay was 33 months (range: 1–122 months). Three AE related deaths (fatality rate 18.8%) were recorded.

AE is an emerging infectious disease in Hungary with a high fatality rate since based on our results, almost every fifth AE patient died in the study period. Differential diagnosis and appropriate surgical and medical therapy for AE is an urging challenge for clinicians in Hungary, as well as in some other European countries where E. multilocularis is prevalent.

• Case series
• Clinical epidemiology
• Echinococcus multilocularis
• Human alveolar echinococcosis
• Hungary

• cyst
• echinococcus
• hydatidosis
• pneumonia
• surgery

The main endemic areas of alveolar echinococcosis (AE) are in Central Europe and Western China. Both the infiltration of intrahepatic vascular and bile duct structures as well as extrahepatic disease can lead to further complications and may increase morbidity in patients with AE.

To evaluate vascular/biliary involvement in hepatic AE and its distant extrahepatic disease manifestations in an international collective was the aim.

Consecutively, five experienced examiners evaluated contrast-enhanced abdominal computed tomography (CT) scans for 200 patients with hepatic AE of each of four locations (n = 50) in Germany, France and China. Therefore, we retrospectively included the 50 most recent abdominal contrast-enhanced CT examinations at each center, performed because of hepatic AE from September 21, 2007 to March 21, 2018. AE liver lesions were classified according to the echinococcosis multilocularis Ulm classification for CT (EMUC-CT). Distant extrahepatic manifestations were documented either by whole body positron emission tomography–CT or with the addition of thoracic CT and cranial magnetic resonance imaging. Vascular/biliary involvement of the hepatic disease as well as the presence of distant extrahepatic manifestations were correlated with the EMUC-CT types of liver lesion. Statistical analysis was performed using SAS Version 9.4 (SAS Institute Inc., Cary, NC, United States).

Distant extrahepatic AE manifestations were significantly more frequent in China than in Europe (P = 0.0091). A significant relationship was found between the presence of distant extrahepatic disease and AE liver lesion size (P = 0.0075). Vascular/biliary structures were involved by the liver lesions significantly more frequently in China than in Europe (P < 0.0001), and vascular/biliary involvement depended on lesion size. Different morphological types of AE liver lesions led to varying frequencies of vascular/biliary involvement and were associated with different frequencies of distant extrahepatic manifestations: Vascular/biliary involvement as a function of lesions primary morphology ranged from 5.88% of type IV liver lesions to 100% among type III lesions. Type IV differed significantly in these associations from types I, II, and III (P < 0.0001). With respect to extrahepatic disease, the primary morphology types IV and V of liver lesions were not associated with any case of distant extrahepatic disease. In contrast, distant extrahepatic manifestations in types I–III were found to varying degrees, with a maximum of 22% for type III.

Different CT morphological patterns of hepatic AE lesions influence vascular/biliary involvement and the occurrence of distant extrahepatic manifestations. There are intercontinental differences regarding the characteristics of AE manifestation.

• Alveolar echinococcosis
• Echinococcus multilocularis
• Echinococcus multilocularis Ulm classification for computed tomography
• Vascular/biliary involvement
• Extrahepatic manifestation
• XUUB project

• Animals
• China/epidemiology
• Echinococcosis
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcosis, Hepatic/epidemiology
• Europe
• France
• Germany
• Humans
• Retrospective Studies

• Echinococcosis multilocularis
• alveolar echinococcosis
• computed tomography
• histology
• humans

Positron emission tomography-computed tomography (PET-CT) with 18F-fluorodesoxyglucose (FDG) is the imaging modality of choice for assessing inflammation surrounding hepatic alveolar echinococcosis (AE) lesions. This study is the first to evaluate FDG uptake in hepatic AE (n = 51) based on the standardized uptake value (SUV) and to correlate the SUVs with primary morphology and calcification patterns, based on the Echinococcus multilocularis Ulm Classification for Computed-Tomography (EMUC-CT). Our results show that the SUVs were increased for lesions with EMUC-CT types I-IV primary morphology, compared to the surrounding healthy liver tissue (SUV = 2.5 ± 0.4; p < 0.05). Type IV lesions included, by far, the highest number of PET-negative lesions. A comparison of lesions with different primary morphologies showed clear differences. The highest SUVs were found for types I and III, and the lowest was found for type IV. Type IV lesions (SUV, 3.8 ± 1.5) showed significantly lower uptake compared to type I (SUV, 6.9 ± 3.5; p = 0.030) and type III (SUV, 7.4 ± 3.9; p = 0.031) lesions. For type II lesions, the results showed only a statistical trend (SUV, 6.1 ± 3.1; p = 0.073). Due to the small number of cases, an evaluation of type V (n = 1) lesions was not possible. The different SUVs of lesions with different primary morphologies, particularly the lower FDG uptake observed in type IV lesions, suggested that these SUVs might reflect different stages of the disease.

• Alveolar echinococcosis
• Echinococcosis multilocularis Ulm Classification for Computed Tomography (EMUC-CT)
• Evolution
• Intercontinental
• Morphology

• Hepatic alveolar echinococcosis
• Ultrasound classification

• Alveolar echinococcosis
• Echinococcus multilocularis
• SF-36
• Therapy

• Altitude
• Alveolar
• Cystic
• Disease control
• Echinococcosis
• Epidemiology
• Health
• Surveillance
• Tibetan
• Transmission ecology

• Echinococcus multilocularis
• 18F-FDG PET/CT
• 18F-FDG PET/MRI
• Alveolar echinococcosis
• échinococcose alvéolaire

• Echinococcus
• Echinococcus granulosus
• Echinococcus multilocularis
• alveolar echinococcosis
• cystic echinococcosis
• echinococcosis
• genetic epidemiology
• genome
• strains/genotypes
• transcriptome
• zoonosis

• Albendazole/therapeutic use
• Animals
• China/epidemiology
• Clinical Trials as Topic
• Cystectomy
• Disease Management
• Echinococcosis/epidemiology
• Echinococcosis/therapy
• Humans
• Quality of Life
• Transplantation, Autologous
• Zoonoses/epidemiology
• Zoonoses/parasitology
• Zoonoses/therapy

• contrast-enhanced ultrasound
• hepatic alveolar echinococcosis
• liver ultrasound

• Adolescent
• Adult
• Aged
• Contrast Media
• Echinococcosis, Hepatic/diagnostic imaging
• Echinococcosis, Hepatic/pathology
• Female
• Humans
• Image Enhancement
• Male
• Middle Aged
• Retrospective Studies
• Ultrasonography
• Young Adult

Alveolar echinococcosis (AE) is a zoonotic disease that is caused by Echinococcus multilocularis that affects liver and a variety of organs and tissues. It differs from other echinococcal disease because it shows tumor like behavior in the affected organ and tissues. The treatment of choice is concomitant medical therapy and resection with negative margins. Nevertheless, resection with the intent of negative margins (R0) may lead to serious complications such as liver failure. In the present case report, we used Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure, which was defined in 2012 by Schnitzbauer et al, in a 28-year-old male patient to avoid complications of major liver resection in order to treat alveolar echinococcosis. Until now, we have not encountered any study using ALPPS procedure for the treatment of alveolar echinococcosis. In the present case report we aimed to show that ALPPS procedure can be safely performed for margin-negative resection of primary or recurrent AE that shows a tumor like behavior. It is our opinion that this procedure should be performed in centers that have expertise and sufficient technical capacity to perform liver transplantation and advanced liver surgery.

• Alveolar echinococcosis
• Extensive disease
• Associating liver partition portal vein ligation
• Curative management