Vascular invasion and regional lymph node involvement in hepatic alveolar echinococcosis on multiphase contrast-enhanced computed tomography: A multicenter retrospective study

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Objective: Regional lymph node involvement is a clinically relevant manifestation of hepatic alveolar echinococcosis (HAE), but its relationship with hepatic vascular invasion remains poorly understood.The aim of our study was to identify clinical and computed tomography (CT) features associated with CT-suspected regional lymph node involvement in patients with HAE.Methods: This multicentre retrospective study included 201 patients with HAE who underwent multiphase contrastenhanced CT.Regional lymph nodes were considered CT-suspicious when morphological abnormalities, including loss of the fatty hilum and internal structural changes, were accompanied by absent or markedly reduced enhancement.Clinical and CT characteristics were compared between patients with and without suspected lymph node involvement, and associated factors were evaluated using logistic regression analysis.Results: The cohort included 113 women (56.2%) and 88 men (43.8%), with a mean age of 37.46 (13.98) years; 97 patients (48.3%) had undergone previous surgery.CT-suspected regional lymph node involvement was identified in 65 patients (32.3%).Pulmonary metastases were more frequent in patients with lymph node involvement (33.8% vs 14.0%; p=0.001).In multiple regression analysis, severe common hepatic artery invasion (adjusted OR 10.54, 95% CI 2.06-54.10;p=0.005) and pulmonary metastases (adjusted OR 2.55, 95% CI 1.20-5.43;p=0.015) were independently associated with lymph node involvement.Conclusion: Severe common hepatic artery invasion and pulmonary metastases were independently associated with CT-suspected regional lymph node involvement in HAE, supporting careful regional lymph node assessment in these patients.