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Background: To correlate the appearance of Alveolar Echinococcosis (AE) hepatic lesions in Magnetic Resonance Imaging (MRI) as defined by Kodama, to the metabolic activity visualized in 18-Fluoro-DeoxyGlucose Positron Emission Tomography combined with Computed Tomography (PET/CT). Methods: Forty-two patients (25 men; mean age: 62.2) diagnosed with AE and who underwent both MRI and PET/CT were included. Three independent readers blinded with regard to the PET/CT information, divided the forty-two hepatic lesions into five types according to Kodama's classification. Concerning PET/CT, two independent readers, unaware of the MRI information, considered the results as positive when an increased FDG-uptake was observed at 1 or 3 hours after FDG injection, and as negative when no increased uptake was noted. Inter-observer agreement was assessed by using j statistics. Results: Forty-two lesions were counted and the mean diameter of overall evaluated lesions was 6.3 cm. One lesion (2.4%) was categorized as type 1, 11 (26.2%) as type 2, 24 (57.1%) as type 3, 3 (7.1%) as type 4 and 3 (7.1%) as type 5. The inter-observer analysis found a j coefficient of 0.96. All type-1, 90.9% of type-2 and 87.5% of type-3 lesions showed an increased FDG-uptake on PET/CT images. All non-microcystic AE liver lesions (types 4, 5) showed no abnormal increased FDG uptake on PET/CT images. The inter-observer analysis at one and three hours found a j coefficient of: 0.95 and 0.92, respectively. Conclusion: In patients with AE liver lesions, the absence of micro-cysts on MRI is strongly correlated to a metabolically inactive disease.
Vuitton et al. (Wed,) studied this question.