A New Classification Of Hepatic Alveolar Echinococcosis(HAE) Calcification And Biological Activity Using CT And PET-CT

Introduction:Hepatic Alveolar echinococcosis?HAE?is a zoonotic diseasecaused by the larval?metacestode?stage of the tapeworm Echinococcus multilocularis.Aim and Objectives:The aim of this study is to establish a pattern of calcification and biological activity in hepatic alveolar echinococcosis?HAE?using CT and PET-CT.The main aim of this dissertation is to re-classify the alveolar echinococcosis using PET-CT and CT,and devise new classification of echinococcosis based on its different calcification patterns during different phase of disease in CT scans and compare them with the biological activity of respective lesion in PET-CT,in order to devise a new mechanism which will help as benchmark to classify disease in areas where PET-CT is not available.This classification will prove to be cost-effective and efficient mechanism of early diagnosing and paving way for more target oriented treatment based on the stage of the disease.This study aims at facilitating the acknowledgment and illustration of HAE lesions and aids to the differential diagnosis of HAE lesions of liver.No other imaging modality is better equipped than ¹⁸F-FDG-PET for initial evaluation and follow up of metabolic activity of HAE lesions.Material and Method:A Retrospective study is conducted on 60 patients in the First Affiliated Hospital of Xinjiang Medical University from June 2016 to April 2017 with confirmed diagnosis of hepatic alveolar echinococcosis or with confirmed diagnosis of surgical pathology of HAE.All patients underwent abdominal CT scan and double-phase enhanced PET-CT examination was confirmed with a single lesion.The CT and PET-CT features were analyzed,and the maximum standard uptake value?SUVmax?of the focal lesion on the PET-CT was measured.According to the calcification,HAE patients were classified into ?,?,? categories.Kruskal-Wallis H test was used to compare the difference of SUVmax between lesions of different HAE types.Result Sixty patients with hepatic alveolar echinococcosis were evenly divided into ?,? and ? categories by different calcifications patterns in CT and biological activity on PET-CT.The median SUVmax of ?,? and ? were 3.41?2.17 to 3.75?,7.45?6.77 to 9.01?and 6.67?6.28 to 9.01?,respectively.The median SUVmax within three types was statistically significant??2=4.429,P<0.05?.Discussion The combination of Computed tomography?CT?,with ¹⁸F-fluorodeoxyglucose positron emission tomography(¹⁸F-FDG-PET),warrants one of the most reliable diagnostic imaging modalities for early diagnosing and monitoring the characteristic calcifications and biological activity in the course of the disease?alveolar echinococcosis?.The biological activity of different calcifications pattern of HAE is different.This is the need of the hour to further strengthen the WHO classification with sub-classifications,which shall help in the context of clinical practice and scientific research using important imaging modulates.This classification may prove as a cost-effective by shortening the duration of chemotherapy than other conventional imaging modalities,based on different types of calcification patterns in CT to determine different biological activity patterns in different stages of the disease.Our research will give a new dimension to unclog the recognition and elucidation of lesions of HAE for the betterment of patients,diseases outcome and its early diagnosis.Conclusion This study is intended to help further differentiate the recognition and interpretation of hepatic lesions based on their calcification pattern and biological activity,and make a ground for future studies.