Evaluation of intrahepatic manifestation and distant extrahepatic disease in alveolar echinococcosis

Table 1 Overview of the echinococcosis multilocularis Ulm classification for computed tomography

Primary morphology (Subcriteria)	Pattern of calcification
Type I, Diffuse infiltrating (with cystoid portion / without cystoid portion)	Without calcifications
Type II, Primarily circumscribed tumor-like (with cystoid portion / without cystoid portion)	With feathery calcifications
Type III, Primarily cystoid - intermediate (IIIa), widespread (IIIb) - (with more solid portions at the edge / without more solid portions at the edge)	With focal calcifications
	With diffuse calcifications
Type IV, Small-cystoid/metastasis-like	With calcifications primarily at the edge
Type V, Mainly calcified	With a central calcification

The two pillars of the classification (Primary morphology and Pattern of calcification) are considered separately in the first instance and then, in principle, can be freely combined. There are two exceptions: the pattern “with a central calcification” can occur only with type IV primary morphology, while type V is not further characterized by a specific pattern of calcification. The focus for further evaluations in this study was on the determination of the main pillar of the classification, the primary morphology.

Table 2 Patient characteristics

	XUUB overall (n = 200)	Xining (n = 50)	Urumqi (n = 50)	Ulm (n = 50)	Besançon (n = 50)
Sex, n (%)
Male	90 (45.0)	22 (44.0)	23 (46.0)	21 (42.0)	24 (48.0)
Female	110 (55.0)	28 (56.0)	27 (54.0)	29 (58.0)	26 (52.0)
Age, yr, n (%)
< 18	8 (4.0)	6 (12.0)	2 (4.0)	0 (0.0)	0 (0.0)
18–40	59 (29.5)	20 (40.0)	26 (52.0)	8 (16.0)	5 (10.0)
41–60	66 (33.0)	24 (48.0)	18 (36.0)	12 (24.0)	12 (24.0)
61–80	50 (25.0)	0 (0.0)	4 (8.0)	26 (52.0)	20 (40.0)
> 81	17 (8.5)	0 (0.0)	0 (0.0)	4 (8.0)	13 (26.0)
Lesion size (mm)	95.6 ± 51.8	108.0 ± 53.0	132.7 ± 46.0	71.4 ± 46.39	70.4 ± 32.3
	(11–261)	(21–261)	(36–253)	(11–202)	(13–173)
Number of lesions	3.2 ± 4.5	3.3 ± 5.3	1.8 ± 1.2	5.0 ± 6.5	2.7 ± 2.4
	(1–29)	(1–27)	(1–6)	(1–29)	(1–12)
Age (yr)	50.1 ± 20.5	35.5 ± 12.6	38.0 ± 13.9	61.3 ± 16.8	65.7 ± 18.3
	(11–91)	(11–55)	(16–77)	(18–85)	(18–91)

Table 3 Primary morphological types classified according to the echinococcosis multilocularis Ulm classification for computed tomography, n (%)

	XUUB total (n = 200)	Xining (n = 50)	Urumqi (n = 50)	Ulm (n = 50)	Besançon (n = 50)
Type I	85 (42.5)	18 (36.0)	17 (34.0)	22 (44.0)	28 (56.0)
With cystoid portion	55 (64.7)	13 (72.2)	13 (76.5)	11 (50.0)	18 (64.3)
Without cystoid portion	30 (35.3)	5 (27.8)	4 (23.5)	11 (50.0)	10 (35.7)
Type II	67 (33.5)	17 (34.0)	26 (52.0)	12 (24.0)	12 (24.0)
With cystoid portion	55 (82.09)	13 (76.5)	22 (84.6)	10 (83.3)	10 (83.3)
Without cystoid portion	12 (17.9)	4 (23.5)	4 (15.4)	2 (16.7)	2 (16.7)
Type III	27 (13.5)	13 (26.0)	7 (14.0)	4 (8.0)	3 (6.0)
With more solid portions at the edge	23 (85.19)	11 (84.6)	6 (85.7)	4 (100.0)	2 (66.7)
Without more solid portions at the edge	4 (14.8)	2 (15.4)	1 (14.3)	0 (0.0)	1 (33.3)
Type iiia	8 (4.0)	2 (4.0)	1 (2.0)	2 (4.0)	3 (6.0)
With more solid portions at the edge	7 (87.5)	0 (0.0)	0 (0.0)	0 (0.0)	2 (66.7)
Without more solid portions at the edge	1 (12.5)	2 (100.0)	1 (100.0)	2 (100.0)	1 (33.3)
Type iiib	19 (9.5)	11 (22.0)	6 (12.0)	2 (4.0)	0 (0.0)
With more solid portions at the edge	16 (84.21)	9 (81.8)	5 (83.3)	0 (0.0)	0 (0.0)
Without more solid portions at the edge	3 (15.8)	2 (18.2)	1 (16.7)	2 (100.0)	0 (0.0)
Type IV	17 (8.5)	2 (4.0)	0 (0.0)	9 (18.0)	6 (12.0)
Type V	4 (2.0)	0 (0.0)	0 (0.0)	3 (6.0)	1 (2.0)

Table 4 Patients with extrahepatic disease manifestation from alveolar echinococcosis

Patient	Center	Age	Sex	Involved organs
No. 1	Besançon	91	Female	Spleen
No. 2	Besançon	86	Male	Cranial calotte
No. 3	Besançon	89	Female	Lung
No. 4	Urumqi	56	Male	Lung
No. 5	Urumqi	49	Male	Lung
No. 6	Urumqi	53	Male	Retroperitoneal (distant from the liver)
No. 7	Urumqi	37	Female	Retroperitoneal (distant from the liver)
No. 8	Urumqi	30	Male	Lung
No. 9	Urumqi	45	Female	Lung
No. 10	Xining	32	Female	Lung
No. 11	Xining	51	Female	Lung
No. 12	Xining	30	Female	Brain, lung
No. 13	Xining	17	Male	Lung
No. 14	Xining	29	Male	Brain, lung
No. 15	Xining	50	Male	Brain, lung
No. 16	Xining	49	Male	Lung