Hepatic Paragonimiasis Revealed by FDG PET/CT

Cheng, Wei; Li, Fang; Zhuang, Hongming; Zhong, Dingrong; Wu, Chenxi; Zhu, Zhaohui

doi:10.1097/rlu.0b013e3181ea33e5

Cited by 19 publications

(4 citation statements)

References 18 publications

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“…Once the liver is infected, it is difficult to distinguish paragonimiasis with HCC. Although FDG PET/CT scans are currently used to diagnose hepatic parasites, FDG activity during malignancy renders them inaccurate [ 14 , 15 ]. Previous studies had demonstrated that the MDCT features of hepatic paragonimiasis were favorable for its specific diagnosis [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Distinct MDCT imaging features to differential diagnosis of hepatic paragonimiasis and small hepatocellular carcinoma

et al. 2017

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We used multi-row detector computed tomography (MDCT) to identify the distinguishing characteristics of hepatic paragonimiasis and small hepatocellular carcinoma lesions. We analyzed a cohort of 60 patients, of which 26 had hepatic paragonimiasis and 34 with a small (≤ 3cm) hepatocellular carcinoma. MDCT detected 65 lesions that were retrospectively reviewed and analyzed based on their imaging features. Both groups showed distinct MDCT imaging features that could contribute to an accurate diagnosis. In the paragonimiasis group, 75% (21/28) lesions were located in the hepatic subcapsular region, whereas only 10.8% (4/37) of lesions in the hepatocellular carcinoma group were subcapsular. Most hepatic paragonimiasis lesions (57.1%; 16/28) also showed characteristic tubular or tunnel features that were not present in hepatocellular carcinomas. Further, 71.4% (20/28) paragonimiasis lesions were rim enhanced with irregular tract-like non-enhanced internal areas with a characteristic target loop, while 94.6% (35/37) of small hepatocellular carcinoma lesions showed homogenous enhancement in the arterial and venous phase. In addition, the period CT values for hepatic paragonimiasis were less than those of hepatic carcinomas (P<0.001). These clinically significant findings illustrate the diagnostic features that enable one to distinguish hepatic paragonimiasis from small hepatocellular carcinomas.

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Section: Discussionmentioning

confidence: 99%

Distinct MDCT imaging features to differential diagnosis of hepatic paragonimiasis and small hepatocellular carcinoma

et al. 2017

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“…Cases of parasitosis suspected as malignancy in PET have been previously reported but are very rare [ 11 – 13 ]. There are no reports investigating the mechanisms of FDG uptake in parasitosis granuloma.…”

Section: Case Presentationmentioning

confidence: 99%

Anisakiasis mimics cancer recurrence: two cases of extragastrointestinal anisakiasis suspected to be recurrence of gynecological cancer on PET-CT and molecular biological investigation

et al. 2016

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BackgroundWe report two cases of anisakiasis lesions that were initially suspected to be recurrence of gynecological cancer by positron emission tomography-computed tomography (PET-CT). Both cases were extragastrointestinal anisakiasis that is very rare.Case presentationThe first case was a patient with endometrial cancer. At 19 months after surgery, a new low density area of 2 cm in diameter in liver segment 4 was found on follow-up CT. In PET-CT, the lesion had abnormal 18fluoro-deoxyglucose (FDG) uptake with elevation in the delayed phase, with no other site showing FDG uptake. Partial liver resection was performed. A pathological examination revealed no evidence of malignancy, but showed necrotic granuloma with severe eosinophil infiltration and an irregular material with a lumen structure in the center. Parasitosis was suspected and consultation with the National Institute of Infectious Diseases (NIID) showed the larvae to be Anisakis simplex sensu stricto by genetic examination.The second case was a patient with low-grade endometrial stromal sarcoma (LG-ESS). At 8 months after surgery, swelling of the mediastinal lymph nodes was detected on CT and peripheral T-cell lymphoma was diagnosed by biopsy. A new peritoneal lesion with abnormal FDG uptake was detected on pre-treatment PET-CT and this lesion was increased in size on post-treatment PET-CT. Tumorectomy was performed based on suspected dissemination of LG-ESS recurrence. The findings in a pathological examination were similar to the first case and we again consulted the NIID. The larvae was identified as Anisakis pegreffi, which is a rare pathogen in humans.Having experienced these rare cases, we investigated the mechanisms of FDG uptake in parasitosis lesions by immunohistochemical staining using antibodies to glucose transporter type 1 (GLUT-1) and hexokinase type 2 (HK-2). While infiltrated eosinophils were negative, macrophages demonstrated positive for both antibodies. Therefore, mechanisms behind FDG uptake may involve macrophages, which is common among various granulomas. This is the first report to investigate parasitosis in such a way.ConclusionThese cases suggest that anisakiasis is a potential differential diagnosis for a lesion with FDG uptake in PET-CT, and that it is difficult to distinguish this disease from a recurrent tumor using PET-CT alone.

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“…Paragonimus larvae, starting their migration track in the intestinal wall, may get access to the liver and there produce parasitic mass lesions. These lesions, most of which consist of a marked inflammatory response, are macroscopic and spherical, mimicking malignancy at imaging (Lee et al 1985(Lee et al , 1987Singcharoen et al 1988;Kim et al 1991Kim et al , 2002Kim et al , 2004Nabeshima et al 1991;Takemasa et al 2002;Cheng et al 2010;Li et al 2012). On CT images, the lesions usually present as clusters of small cysts with rim enhancement in peripheral parts of the liver (Kim et al 2004).…”

Section: Liver Involvementmentioning

confidence: 99%

Tumor-like Parasitic Lesions of the Hepatobiliary Tract: Liver Flukes and Other Trematodes

Zimmermann¹

2016

Tumors and Tumor-Like Lesions of the Hepatobiliary Tract

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Hepatic Paragonimiasis Revealed by FDG PET/CT

Cited by 19 publications

References 18 publications

Distinct MDCT imaging features to differential diagnosis of hepatic paragonimiasis and small hepatocellular carcinoma

Distinct MDCT imaging features to differential diagnosis of hepatic paragonimiasis and small hepatocellular carcinoma

Anisakiasis mimics cancer recurrence: two cases of extragastrointestinal anisakiasis suspected to be recurrence of gynecological cancer on PET-CT and molecular biological investigation

Tumor-like Parasitic Lesions of the Hepatobiliary Tract: Liver Flukes and Other Trematodes

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