Abstract
The availability of different therapeutic alternatives in hydatid liver disease necessitates a comprehensive classification system in order to evaluate indications and monitor results. We have proposed a new scheme in which lesions are graded 1–5 according to the morphology of the cyst and the presence of findings in favour of cyst rupture. Ultrasound (US), CT and cholangiographic findings in 214 hydatid liver lesions in 152 patients who underwent surgery within 15 days of their radiological examinations were evaluated retrospectively. Results of the radiological classification were correlated with surgical data. We found that purely cystic unilocular lesions never ruptured, that dilatation of biliary canaliculi around a lesion with a complex morphological appearance is a non-specific finding and that there was no reliable radiological sign for a simple biliary communication. US, CT and cholangiography were reliable in diagnosing intra-biliary and direct ruptures. We conclude that the proposed grading scheme could be useful in monitoring the results of different therapeutic modalities for hydatid disease of the liver and, with the accumulation of further data, could be helpful in allocating patients to therapeutic alternatives.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Saidi F (1976) Surgery of hydatid disease. Saunders, Philadelphia
Moires DL, Dykes PW, Marriner S, et al (1985) Albendazole: objective evidence of response in human hydatid disease. JAMA 253: 2053–2057
Bekhti A, Schaaps JP, Capron M, Dessaint JP, Santoro F, Capron A (1977) Treatment of hepatic hydatid disease with mebendazole: preliminary results in four cases. BMJ II: 1047–1051
Todorov T, Vutova K, Mechkov G, Petkov D, Nedelkov G, Tonchev Z (1990) Evaluation of response to chemotherapy of human cystic echinococcosis. Br J Radiol 63: 523–531
Mueller PR, Dawson SL, Ferrucci JT, Nardi GL (1985) Hepatic echinococcal cyst: successful percutaneous drainage. Radiology 155: 627–628
Bret PM, Fond A, Bretagnolle M, et al (1988) Percutaneous aspiration and drainage of hydatid cysts in the liver. Radiology 168: 617–620
Filice C, Pirola F, Brunetti SD, Stroselli M, Foglieni CS (1990) A new therapeutic approach for hydatid liver cysts: aspiration and alcohol injection under sonographic guidance. Gastroenterology 98: 1366–1368
Acunas B, Rozanes I, Acunas G, Celik L, Alper A, Gökmen E (1991) Hydatid cyst of the liver: identification of detached cyst lining on CT scans obtained after cyst puncture. AJR 156: 751–752
Khuroo MS, Zargar SA, Mahajan R (1991) Echinococcus granulosus cyst in the liver: management with percutaneous drainage. Radiology 180: 141–145
Acunas B, Rozanes I, Celik L, et al (1992) Purely cystic hydatid disease of the liver: treatment with percutaneous aspiration and injection of hypertonic saline. Radiology 182: 541–543
Filice C, Strosselli M, Brunetti E, Colombo P, D'Andrea F (1992) Percutaneous drainage of hydatid liver cysts. Radiology 184: 579–580
Giorgio A, Tarantino L, Francica G, et al (1992) Unilocular hydatid liver cysts: treatment with US-guided, double percutaneous aspiration and alcohol injection. Radiology 184: 705–710
Saremi F (1992) Percutaneous drainage of hydatid cysts: use of a new cutting device to avoid leakage. AJR 158: 83–85
Lewell DB, McCorkell SJ (1985) Hepatic echinococcal cysts: sonographic appearance and classification. Radiology 155: 773–775
Niron EA, Özer H (1981) Ultrasound appearances of liver hydatid disease. Br J Radiol 54: 335–338
Gharbi HA, Hassine W, Brauner MW, Dupuch K (1981) Ultrasound examination of the hydatic liver. Radiology 139: 459–463
Esfahani F, Rooholamini SA, Vessal K (1988) Ultrasonography of hepatic hydatid cysts: new diagnostic signs. J Ultrasound Med 7: 443–450
Lewall DB, McCorkell SJ (1986) Rupture of echinococcal cysts: diagnosis, classification, and clinical implications. AJR 146: 391–394
Hankins JR (1963) Management of complicated hepatic hydatid cysts. Ann Surg 158: 1020–1034
Magistrelli P, Masetti R, Coppola R, et al (1989) Value of ERCP in the diagnosis and management of pre-and postoperative biliary complications in hydatid disease of the liver. Gastrointest Radiol 14: 315–320
Marti-Bonmati L, Serrano FM (1990) Complications of hepatic hydatid cysts: ultrasound, computed tomography, and magnetic resonance diagnosis. Gastrointest Radiol 15: 119–125
Ertan A, Sahin B, Kandilci U, Acikalin T, Cuhhur T, Danisoglu V (1983) The mechanism of cholestasis from hepatic hydatid cysts. J Clin Gastroenterol 5: 437–440
Alper A, Ariogul O, Emre A, Uras A, Ökten A (1987) Choledochoduodenostomy for intra-biliary rupture of hydatid cysts of liver. Br J Surg 74: 243–245
Sinner WN von (1990) Ultrasound, CT and MRI of ruptured and disseminated hydatid cysts. Eur J Radiol 11: 31–37
Author information
Authors and Affiliations
Additional information
Correspondence to: I. Rozanes
Rights and permissions
About this article
Cite this article
Rozanes, I., Acunas, B., Celik, L. et al. Grading of liver lesions caused by Echinococcus granulosus. Eur. Radiol. 3, 429–433 (1993). https://doi.org/10.1007/BF00221419
Issue Date:
DOI: https://doi.org/10.1007/BF00221419