Consistency study of ultrasound classification for hepatic alveolar echinococcosis based on pathological features

doi:10.12140/j.issn.1000-7423.2026.03.005

Abstract

Abstract:

Objective To propose a 4-type ultrasound classification system based on the pathological features of hepatic alveolar echinococcosis (HAE), and to explore its consistency with pathological classification and clinical application value. Methods A retrospective analysis was performed on patients who were pathologically diagnosed with HAE after surgery at the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2024. The ultrasound data, pathological data and treatment modalities of the patients were collected. Ultrasound examinations were conducted to record the location, maximum diameter, internal echo of the lesion, liquefactive necrosis area and calcification range. Referring to the ultrasound results and postoperative pathological features of the lesions, the lesions were divided into 4 types: infiltrative type, calcified type, liquefied type and complex type. The inter-observer consistency of ultrasound classification and the consistency between ultrasound classification and pathological results were comparatively analyzed, and the consistency evaluation was performed using the Kappa value. The differences in ultrasound-related parameters among the 4 types of lesions were compared, including the maximum diameter, the proportion of solid area, the proportion of calcified area, the proportion of liquefied area, and the hypoechoic halo around the lesion. The patient type was determined based on the classification of the largest lesion of the patient, and the clinical treatment measures of the patients were collected simultaneously to analyze the correlation between patient types and treatment modalities. Statistical analysis was carried out using SPSS 26.0 software. Results A total of 344 HAE patients and 469 HAE lesions were finally included. The ultrasound classification results showed 227 infiltrative lesions, 73 calcified lesions, 106 liquefied lesions and 63 complex lesions; the pathological classification results showed 217 infiltrative lesions, 81 calcified lesions, 110 liquefied lesions and 61 complex lesions. The overall coincidence rate of ultrasound classification was 94.5% (443/469), and the coincidence rates of each type of lesion were 100% (73/73) for calcified type, 97.2% (103/106) for liquefied type, 92.5% (210/227) for infiltrative type, and 90.5% (57/63) for complex type, respectively. The inter-observer consistency Kappa value was 0.936, and the Kappa value for the consistency between ultrasound classification and pathological results was 0.918. The differences in the proportions of solid, calcified, liquefied components and the maximum diameter among the 4 types of lesions were all statistically significant (H = 381.729, 237.657, 384.372, 101.102, all P < 0.05). 76.7% (264/344) of the patients underwent radical resection for HAE, 21.2% (73/344) underwent autologous liver transplantation, and 2.0% (7/344) underwent allogeneic liver transplantation. Preoperatively, 12.8% (44/344) of the patients received palliative treatment, including 16 cases of percutaneous transhepatic biliary decompression, and 25 cases of liquefied type and 3 cases of complex type underwent puncture drainage of the abscess cavity. The proportions of patients with different types were 44.5% (153/344) for infiltrative type, 12.5% (43/344) for calcified type, 27.3% (94/344) for liquefied type, and 15.7% (54/344) for complex type. Correlation analysis showed that there was a statistically significant difference in the selection rate of abscess cavity puncture and drainage among different patient types (χ² = 47.32, P < 0.01). Although the difference in the selection rate of radical lesion resection among different patient types was statistically significant (χ² = 10.47, P < 0.05), after Bonferroni correction (α = 0.008 33), there was no statistically significant difference in the selection rate between any two types. Conclusion This HAE ultrasound classification is highly consistent with pathological features and demonstrates high reproducibility, with each subtype possessing characteristic ultrasound parameters. This classification method, by identifying the main components of the lesion preoperatively, provides the imaging basis for the individualized treatment of hepatic alveolar echinococcosis.

Key words: Hepatic alveolar echinococcosis, Ultrasound classification, Pathological features, Clinical treatment, Consistency

CLC Number:

R532.32

WANG Zirui, WANG Xiaorong, YANG Lingfei, LI Zhao, LIU Xiaofeng, SONG Tao. Consistency study of ultrasound classification for hepatic alveolar echinococcosis based on pathological features[J]. CHINESE JOURNAL OF PARASITOLOGY AND PARASITIC DISEASES, 2026, 44(3): 343-350.

Figures/Tables 8

Table 1

Table 2

Table 3

Table 4

Fig. 1

Table 5

Table 6

Table 7

References 16

[1]	Ma T, Wang Q, Hao MM, et al. Epidemiological characteristics and risk factors for cystic and alveolar echinococcosis in China: an analysis of a national population-based field survey[J]. Parasit Vectors, 2023, 16(1): 181.
[2]	中国医师协会外科医师分会包虫病外科专业委员会. 肝两型包虫病诊断与治疗专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(8): 711-721.
	Chinese Doctor Association, Chinese College of Surgeons (CCS); State Key Laboratory of Pathogenesis, Prevention. Expert consensus on diagnosis and treatment of hepatic cystic and alveolar echinococcosis (2019 edition)[J]. Chin J Dig Surg, 2019, 18(8): 711-721. (in Chinese)
[3]	Brunetti E, Kern P, Vuitton DA. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans[J]. Acta Trop, 2010, 114(1): 1-16.
[4]	Kratzer W, Gruener B, Kaltenbach TE, et al. Proposal of an ultrasonographic classification for hepatic alveolar echinococcosis: echinococcosis multilocularis Ulm classification-ultrasound[J]. World J Gastroenterol, 2015, 21(43): 12392-12402.
[5]	王文涛, 杨先伟. 复杂肝泡型包虫病诊疗专家共识(2020版)[J]. 中国普外基础与临床杂志, 2020, 27(1): 18-23.
	Wang WT, Yang XW. Expert consensus on diagnosis and management of complicated hepatic alveolar echinococcosis (2020 edition)[J]. Chin J Bases Clin Gen Surg, 2020, 27(1): 18-23. (in Chinese)
[6]	蒲昆明, 李金花, 袁孟霞, 等. 四川省甘孜州北部地区肝包虫病超声诊断及分型[J]. 四川医学, 2020, 41(6): 640-643.
	Pu KM, Li JH, Yuan MX, et al. Ultrasonic diagnosis and typing of hepatic hydatid disease in northern Ganzi prefecture Sichuan Province[J]. Sichuan Med J, 2020, 41(6): 640-643. (in Chinese)
[7]	Geschwind JF, Artemov D, Abraham S, et al. Chemoembolization of liver tumor in a rabbit model: assessment of tumor cell death with diffusion-weighted MR imaging and histologic analysis[J]. J Vasc Interv Radiol, 2000, 11(10): 1245-1255.
[8]	叶帅, 赵建卿, 蒋奕, 等. 肝泡型包虫病的钙化特点及其生物学活性[J]. 中华放射学杂志, 2018, 52(4): 283-285.
	Ye S, Zhao JQ, Jiang Y, et al. Calcification characteristics and biological activity of hepatic alveolar echinococcosis[J]. Chin J Radiol, 2018, 52(4): 283-285. (in Chinese)
[9]	古代娇, 唐世孝. 超声引导下经皮肝穿刺胆道引流术治疗肝泡型包虫病合并梗阻性黄疸的临床疗效观察[J]. 实用医院临床杂志, 2019, 16(4): 52-54.
	Gu DJ, Tang SX. A research of ultrasound guided percutaneous transhepatic cholangial drainage for the treatment of hepatic alveolar echinococcosis combined with obstructive jaundice[J]. Pract J Clin Med, 2019, 16(4): 52-54. (in Chinese)
[10]	张灵强, 王鹏, 阳丹才让, 等. 超声引导下穿刺引流联合手术切除治疗液化空洞型肝泡型包虫病的疗效及安全性[J]. 中华肝胆外科杂志, 2017, 23(8): 535-538.
	Zhang LQ, Wang P, Yang D, et al. Treatment efficacy and safety of ultrasound-guided puncture combined with surgical resection for liquefied cavitary hepatic alveolar echinococcosis[J]. Chin J Hepatobiliary Surg, 2017, 23(8): 535-538. (in Chinese)
[11]	祖力皮喀尔·图孙尼亚孜, 蒋铁民, 温浩. 肝多房棘球蚴病的手术治疗进展[J]. 中国寄生虫学与寄生虫病杂志, 2024, 42(6): 83-789.
	Zulipikaer T, Jiang TM, Wen H. Advances in surgical treatment of hepatic alveolar echinococcosis[J]. Chin J Parasitol Parasit Dis, 2024, 42(6): : 783-789. (in Chinese)
[12]	Schuhbaur J, Schweizer M, Philipp J, et al. Long-term follow-up of liver alveolar echinococcosis using echinococcosis multilocularis ultrasound classification[J]. World J Gastroenterol, 2021, 27(40): 6939-6950.
[13]	徐凯, 王志鑫, 樊海宁, 等. 肝棘球蚴病误诊肝癌1例报告[J]. 中国寄生虫学与寄生虫病杂志, 2021, 39(3): 420-421.
	Xu K, Wang ZX, Fan HN, et al. A case of hepatic hydatid disease misdiagnosed as liver cancer[J]. Chin J Parasitol Parasit Dis, 2021, 39(3): 420-421. (in Chinese)
[14]	You XY, Liu T, Yang C, et al. Hepatic cavernous hemangioma misdiagnosed as hepatic alveolar echinococcosis[J]. Asian J Surg, 2025, 48(1): 722-724.
[15]	Wang HY, Xia Q, Wang XL, et al. Misdiagnosis of a patient with hepatic alveolar echinococcosis with hepatapostema: a case report[J]. Iran J Parasitol, 2023, 18(4): 563-567.
[16]	阿米娜·依布拉音, 秦永德, 巴雅, 等. 18F-FDG PET/CT延迟相在肝泡型包虫病药物疗效中的评估价值[J]. 分子影像学杂志, 2025, 48(8): 940-945.
	Amina Y, Qin YD, Ba Y, et al. Evaluation value of 18F-FDG PET/CT delayed imaging in the drug efficacy of hepatic alveolar echinococcosis[J]. J Mol Imaging, 2025, 48(8): 940-945. (in Chinese)

特征 Characteristic	例数 No. cases	构成比/% Proportion/%
性别 Sex
男 Male	164	47.7
女 Female	180	52.3
年龄组 Age group
< 40	178	51.7
40~59	142	41.3
≥ 60	24	7.0
民族 Nationality
藏族 Tibetan	217	63.1
哈萨克族 Kazakh	55	16.0
汉族 Han	43	12.5
蒙古族 Mongol	11	3.2
其他 Other	18	5.2
畜牧区居住史 History of residence in a livestock-raising area
有 Yes	260	75.6
无 No	84	24.4
犬类接触史 History of exposure to dogs
有 Yes	230	66.9
无 No	114	33.1
病灶多发 Multiplicity of lesions
是 Yes	89	25.9
否 No	255	74.1
合计 Total	344	100

超声特征 Ultrasound characteristics	病灶数 No. lesions	构成比/% Proportion/%
位置 Location
左叶 Left lobe	130	27.7
右叶 Right lobe	233	49.7
左叶及右叶 Both left and right lobes	106	22.6
最大直径/mm Maximum diameter/mm
< 50	69	14.7
50~< 100	167	35.6
100~< 150	146	31.1
150~< 200	68	14.5
≥ 200	19	4.1
内部液化腔 Internal liquefactive cavity
有 Yes	239	51.0
无 No	230	49.0
钙化 Calcification
有 Yes	409	87.2
无 No	60	12.8
合计 Total	469	100

超声医师B分型结果 Classification results of sonographer B	超声医师A分型结果 Classification results of sonographer A
超声医师B分型结果 Classification results of sonographer B	浸润型 Infiltrative type	钙化型 Calcified type	液化型 Liquefied type	复杂型 Complex type	合计 Total
浸润型 Infiltrative type	222	1	1	0	224
钙化型 Calcified type	2	72	0	0	74
液化型 Liquefied type	5	0	98	2	105
复杂型 Complex type	7	0	2	57	66
合计 Total	236	73	101	59	469

超声分型 Ultrasound classification	病灶超声参数 Ultrasound parameter
超声分型 Ultrasound classification	中位最大直径/mm（25%，75%） Median maximum diameter/mm (25%, 75%)	实性成分占比/%（25%，75%） Proportion of solid component/% (25%, 75%)	钙化成分占比/% （25%，75%） Proportion of calcified component/% (25%, 75%)	液化成分占比/% （25%，75%） Proportion of liquefied component/% (25%, 75%)	伴低回声晕病灶占比/% Proportion of lesion with hypoechoic halo/%
浸润型 Infiltrative type	84.0（55.5，117.0）	87.0（70.0，100）	8.0（0，17.5）	0（0，10.5）	15.9（36/227）
钙化型 Calcified type	68.0（45.0，95.0）	35.0（15.0，35.0）	65.0（65.0，84.0）	0（0，0）	8.2（6/73）
液化型 Liquefied type	139.5（108.5，173.8）	22.0（14.5，35.0）	7.0（4.3，7.0）	67.0（58.0，80.5）	2.8（3/106）
复杂型 Complex type	107.0（84.0，132.0）	42.0（39.0，46.5）	15.0（14.5，15.0）	40.0（37.5，46.0）	4.8（3/63）
检验值 Test value	H = 101.102	H = 381.729	H = 237.657	H = 384.372	χ² = 71.21
P值 P value	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

手术方式 Surgical procedure	术前姑息治疗 Preoperative palliative care			术前无姑息治疗 No preoperative palliative care	合计 Total
手术方式 Surgical procedure	脓腔穿刺置管引流术 Percutaneous catheter drainage of abscess	经皮肝穿刺胆道减压术 Percutaneous transhepatic biliary drainage	联合姑息治疗 Combined palliative treatment	术前无姑息治疗 No preoperative palliative care	合计 Total
根治性切除术 Radical resection	20	16	2	226	264
自体肝移植 Autologous liver transplantation	6	0	0	67	73
异体肝移植 Autologous liver transplantation	0	0	0	7	7
合计 Total	26	16	2	300	344