EURORAD ESR

Case 14624

Improved characterisation of cystic liver echinococcosis by MRI

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy; E
mail:mtonolini@sirm.org
 
Patient
female, 29 year(s)
 
 
  • Figure 1
    Liver ultrasound

    A large (7-cm) well-demarcated ovoid-shaped lesion, with thin regular wall (thin arrows) was detected in the right liver lobe; the mass was mostly echogenic (*) at the periphery with central serpiginous hypo-anechoic...

     
    Area of Interest: Liver; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 2
    Unenhanced and post-contrast multidetector CT
     

    Precontrast CT confirmed a large ovoid-shaped mass in the right liver lobe, with thin regular hypoattenuating wall (thin arrows), peripheral solid (25-35 Hounsfield units - HU) portions (*) and central hypodensity...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Arterial-dominant (b,c) images confirmed well-demarcated ovoid liver mass with thin, uniformly enhancing wall (thin arrows). No enhancement in both central hypoattenuation (+) and peripheral solid-attenuation...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    Arterial-dominant (b,c) images confirmed well-demarcated ovoid liver mass with thin, uniformly enhancing wall (thin arrows). No enhancement in both central hypoattenuation (+) and peripheral solid-attenuation...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    In portal-venous (d,e) and equilibrium (f) phases the ovoid mass in the right liver lobe did not enhance. Note thin regular peripheral wall (thin arrows), central hypoattenuation (+), peripheral solid-attenuation...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    In portal-venous (d,e) and equilibrium (f) phases the ovoid mass in the right liver lobe did not enhance. Note thin regular peripheral wall (thin arrows), central hypoattenuation (+), peripheral solid-attenuation...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;

    In equilibrium (f) phase the ovoid mass in the right liver lobe did not enhance. Note central hypoattenuation (+), peripheral solid-attenuation components (*), with lobulated margins (arrows), dilated intrahepatic...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 3
    Unenhanced liver MRI
     

    T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous...

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;

    On T1-weighted imaging the peripheral pseudo-solid components (*) were nearly isointense compared to liver, the central matrix (+) had very low fluid-like signal with serpiginous "canalicular" appearance (arrows).

     
    Area of Interest: Liver; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
  • Figure 4
    WHO Informal Working Group (2003) sonographic classification of cystic liver echinococcosis

    The ultrasound-based WHO-IWG currently represents the standardized staging approach, differentiates active cysts from transitional forms and inactive degenerated echinococcosis.

     
    Area of Interest: Liver; Imaging Technique: Ultrasound; Procedure: Diagnostic procedure; Special Focus: Parasites;
     
     
A large (7-cm) well-demarcated ovoid-shaped lesion, with thin regular wall (thin arrows) was detected in the right liver lobe; the mass was mostly echogenic (*) at the periphery with central serpiginous hypo-anechoic component.
 
Precontrast CT confirmed a large ovoid-shaped mass in the right liver lobe, with thin regular hypoattenuating wall (thin arrows), peripheral solid (25-35 Hounsfield units - HU) portions (*) and central hypodensity (15-18 HU, +), without any calcification.
 
Arterial-dominant (b,c) images confirmed well-demarcated ovoid liver mass with thin, uniformly enhancing wall (thin arrows). No enhancement in both central hypoattenuation (+) and peripheral solid-attenuation components (*), with lobulated margins (arrows).
 
Arterial-dominant (b,c) images confirmed well-demarcated ovoid liver mass with thin, uniformly enhancing wall (thin arrows). No enhancement in both central hypoattenuation (+) and peripheral solid-attenuation components (*).
 
In portal-venous (d,e) and equilibrium (f) phases the ovoid mass in the right liver lobe did not enhance. Note thin regular peripheral wall (thin arrows), central hypoattenuation (+), peripheral solid-attenuation components (*), with lobulated margins (arrows).
 
In portal-venous (d,e) and equilibrium (f) phases the ovoid mass in the right liver lobe did not enhance. Note thin regular peripheral wall (thin arrows), central hypoattenuation (+), peripheral solid-attenuation components (*).
 
In equilibrium (f) phase the ovoid mass in the right liver lobe did not enhance. Note central hypoattenuation (+), peripheral solid-attenuation components (*), with lobulated margins (arrows), dilated intrahepatic bile duct (arrowheads) from compression.
 
T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous "canalicular" appearance (arrows) of alternating signal intensities.
 
T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous "canalicular" appearance (arrows) of alternating signal intensities.
 
T2-weighted images confirmed large ovoid liver mass, demarcated by thin regular hypointense wall (thin arrows), peripheral low-to-intermediate signal compontents (*), central fluid-like matrix (+) with serpiginous "canalicular" appearance (arrows) of alternating signal intensities.
 
On T1-weighted imaging the peripheral pseudo-solid components (*) were nearly isointense compared to liver, the central matrix (+) had very low fluid-like signal with serpiginous "canalicular" appearance (arrows).
 
The ultrasound-based WHO-IWG currently represents the standardized staging approach, differentiates active cysts from transitional forms and inactive degenerated echinococcosis.
 
 
 
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