The role of calcification for staging cystic echinococcosis (CE)

The prevalence of calcified cysts and the significance of calcification as a sign of cyst inactivity in cystic echinococcosis (CE) was evaluated. Seventy-eight patients (36 females, 42 males, mean age 40.8 +/- 16.9 years) with CE, having a total of 137 abdominal cysts (116 hepatic, three splenic, one renal and 17 peritoneal cysts), were diagnosed and followed-up by ultrasound during and after albendazole treatment or as part of the watch-and-wait approach recording changes in the cyst wall and content. In 48 patients with 94 cysts, computed tomography (CT) imaging was additionally available and was correlated with ultrasound findings. Cyst wall calcification was classified into (1) "sprinkled", (2) "eggshell-like", and (3) "circular". Calcification of the cyst wall and/or cyst content was detected in 67 echinococcal cysts (48.9% of all cysts) in 39 patients (15 females, 24 males, mean age 40.8 +/- 14.8 years). Of the total of 67 calcified cysts, only 23 were compatible with WHO type CE5, 18 with WHO type CE4. Judged by cyst content, the remaining 26 were of WHO type CE1, CE2 and CE3 (n = 1, n = 8, and n = 17, respectively). During a mean period of 34.3 months (+/- 21.3 months) the majority of cysts (n = 32) did not exhibit any change in cyst content and wall properties. Fourteen cysts showed signs of progressive involution, five cysts (all of WHO type CE3) of renewed activity defined by recurring fluid collection. In 16 cysts, no follow-up was available due to surgery or drop out. Calcification of the cyst is not restricted to the inactive WHO cyst types CE4 and CE5, but occurs in all stages and in up to 50% of cysts. The completeness and, most importantly, the stability of consolidation of cyst content over time predicts cyst inactivity more reliably.