Differential diagnosis between hepatic alveolar echinococcosis and intrahepatic cholangiocarcinoma with conventional ultrasound and contrast-enhanced ultrasound.

BACKGROUND: Misclassifications of hepatic alveolar echinococcosis (HAE) as intrahepatic cholangiocarcinoma (ICC) may lead to inappropriate treatment strategies. The aim of this study was to explore the differential diagnosis with conventional ultrasound and contrast-enhanced ultrasound (CEUS). METHODS: Sixty HAE lesions with 60 propensity score-matched ICC lesions were retrospectively collected. The 120 lesions were randomly divided into a training set (n = 80) and a testing set (n = 40). In the training set, the most useful independent conventional ultrasound and CEUS features was selected for differentiating between HAE and ICC. Then, a simplified US scoring system for diagnosing HAE was constructed based on selected features with weighted coefficients. The constructed US score for HAE was validated in both the training set and the testing set, and diagnostic performance was evaluated. RESULTS: Compared with ICC lesions, HAE lesions were mostly located in the right lobe and had mixed echogenicity, a pseudocystic appearance and foci calcifications on conventional ultrasound. On CEUS, HAE lesions showed more regular rim-like enhancement than ICC lesions and had late washout with a long enhancement duration. The simplified US score consisted of echogenicity, pseudocystic/calcification, bile duct dilatation, enhancement pattern, enhancement duration, and marked washout. In the testing set, the sensitivity, specificity, LR+, LR- and the area under the ROC curve for the score to differentiate HAE from ICC were 80.0, 81.3%, 4.27, 0.25 and 0.905, respectively. CONCLUSIONS: The US score based on typical features from both conventional ultrasound and CEUS could accurately differentiate HAE from ICC.

Microwave ablation combining surgery for the treatment of multiorgan cystic echinococcosis: A case report.

Cystic echinococcosis (CE) is a global public health problem associated with a high overall disease burden. Multiple organ systems are involved in approximately 20% of cases, and treatment is challenging and rarely reported. In this study, we described microwave ablation (MWA) combining surgery for the treatment of a multiorgan CE patient. The patient underwent percutaneous MWA for a hepatic CE3b lesion and exploratory resection of the pelvic cavity lesions. The hepatic lesion was effectively treated by MWA, and invasiveness was reduced by avoiding hepatectomy. The patient had a favorable prognosis at a 20-month's follow-up. More studies are needed to evaluate its usefulness in CE treatment.

Thermal Field Distributions of Ablative Experiments Using Cyst-mimicking Phantoms: Comparison of Microwave and Radiofrequency Ablation.

RATIONALE AND OBJECTIVES: The objective of this study was to explore the thermal field distribution of cystic lesions undergoing microwave ablation (MWA) and radiofrequency ablation (RFA) using in vitro phantoms. MATERIALS AND METHODS: Cyst-mimicking lesions filled with sodium chloride (NaCl) solution in acrylamide phantoms were treated with MWA and RFA in vitro. The radiofrequency electrodes or MWA antennas were implanted in the centers of the artificial cystic lesions. We used temperature fields located 5, 15, and 25 mm from the electrode or the antenna to plot the temperature-rise curves. Solid phantoms without cysts were also fabricated as controls. RESULTS: The temperature within cysts increased faster and reached a higher maximum temperature during MWA than during RFA, and this result was independent of the NaCl solution concentration. RFA treatment caused the temperatures within the lesion to increase significantly faster in the cysts containing 0.9% NaCl than in those containing 5.0% NaCl. However, the MWA temperature-rise curves were only weakly affected by the ionic concentration. The median temperature difference values between the 5- and 15-mm points were markedly lower in the 0.9% NaCl cyst-mimicking phantom (P <0.001) than in the solid phantom after either MWA or RFA. CONCLUSIONS: Our data indicate that MWA is a more effective technique for focal cystic lesions than RFA and has higher overall energy utilization. MWA was also less affected by the ionic concentration of the cystic fluid.