Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Diffusion-Weighted MRI for the Initial Viability Evaluation of Parasites in Hepatic Alveolar Echinococcosis: Comparison with Positron Emission Tomography

  • Zheng, Jianjun (Department of Radiology, Ningbo N.2 Hospital) ;
  • Wang, Jing (Imaging Center, First Teaching Hospital, Xinjiang Medical University) ;
  • Zhao, Jianqing (Imaging Center, First Teaching Hospital, Xinjiang Medical University) ;
  • Meng, Xianyun (Department of Radiology, Ningbo N.2 Hospital)
  • Received : 2017.01.22
  • Accepted : 2017.04.19
  • Published : 2018.02.01
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Abstract

Objective: More than 70% of hepatic alveolar echinococcosis (HAE) are inoperable. Thus, long-term, or even life-long, pharmacological treatment with benzimidazoles is necessary. For effective treatment, it is of great importance to employ imaging techniques to detect and monitor the non-resectable parasitic viability. Therefore, this study aimed to evaluate diffusion-weighted imaging (DWI) in assessing the viability of HAE in comparison to 18-fluoro-deoxyglucose (18F-FDG) positron emission tomography, combined with computed tomography (PET/CT). Materials and Methods: Positron emission tomography, computed tomography and DWI (b-values: 0, $800s/mm^2$) were retrospectively analysed in eight patients with clinically-verified HAE to, generate the apparent diffusion coefficient (ADC) map. The activity of HAE lesions in both techniques were determined independently by two radiologists according to the following standard: (+), marked focally or perilesionally increased FDG uptake/high signal intensity; (-), a hepatic defect without FDG uptake/no high signal intensity. Every lesion's maximum standardized uptake value ($SUV_{max}$) on the PET/CT images and mean ADC values on the parametric ADC maps were measured respectively. Results of PET/CT and DWI were compared on a per-lesion-basis. Pearson's correlation coefficient was assessed for statistical analysis. Results: A total of 14 HAE lesions were detected. Eight lesions (diameter 3-15 cm) showed perilesional hyper-signal intensity on DWI. This was visualised on PET/CT as increased FDG uptake. They mainly existed in the lesion's border with normal liver parenchyma. Five lesions (diameter < 2 cm) were detected as nodular hyperintensity on DWI and a 'hot spot' on PET/CT in the same distribution. One patient, who had received oral drug therapy for three years showed significantly decreased perilesional hyperintensity on the DWI and a hepatic defect without any FDG uptake on PET/CT. Pearson's correlation coefficient indicated a significant inverse correlation of the ADC and the $SUV_{max}$ (r = -0.67, p < 0.001). Conclusion: Diffusion-weighted imaging is capable of offering information on visually detecting the HAE lesions' viability and may be useful for routine application in the initial diagnosis of HAE.

Keywords

Acknowledgement

Supported by : National Natural Science Foundation of China

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