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Kodama-XUUB: an informative classification for alveolar echinococcosis hepatic lesions on magnetic resonance imaging
Éléonore Brumpt1, Wenya Liu2, Tilmann Graeter3
1University Bourgogne Franche-Comté (UFC) and Besançon University Hospital, WHO Collaborating Centre on Prevention and Treatment of Human Echinococcosis/National French Reference Centre for Echinococcosis, UMR 6249 CNRS-UFC Chrono-environment, 25030 Besançon, France - Department of Anatomy, University of Franche-Comté, 25000 Besançon, France - Nanomedicine Laboratory, INSERM EA 4662, University of Franche-Comté, 25000 Besançon, France.
Objective:
To propose a modification of the Kodama classification to classify type III lesions of alveolar echinococcosis (AE) that do not have microcysts.
Materials And Methods:
200 magnetic resonance imaging (MRI) images of AE liver lesions from four endemic regions of the world were classified according to Kodama, distinguishing within type III those with microcysts from those without. Each center included 50 MRIs of patients with unoperated AA liver lesions. The first 50 cases were classified by a first reader in the presence of four second-line readers from each region. Then each second-line reader classified his or her 50 cases.
Results:
In all centers, type III lesions were predominant: 58% of the total lesions and 23% of them were without microcysts. The average age of the patients was 47 years. In China, the patients were on average younger and the lesions larger. German patients had more lesions within the liver. Type I and II lesions, synonymous with earlier diagnosis, were more common in Europe.
Conclusion:
The Kodama classification needed to be modified because of the existence of a significant proportion of unclassifiable lesions. This is especially true since the presence of microcysts is an informative element of parasite activity. Therefore, this study proposes a Kodama-XUUB classification with type IIIa lesions having microcysts and type IIIb lesions not having microcysts.
