The Role of Interventional Radiology for the Treatment of Liver CE and AE Lesions: Current Concepts

Although they are evaluated in the same disease spectrum, the physiopathologies, diagnoses, treatment management strategies, and prognoses of AE and CE differ completely. Management of both diseases requires a multidisciplinary approach involving many branches such as surgery, interventional radiology, gastroenterology, anesthesia, and infectious diseases. The technical success of any AE or CE treatment depends largely on the technical skills and experience of the surgeon, gastroenterologist, or interventional radiologist, but the clinical success of the treatment depends on multidisciplinary collaboration to prevent and manage complications.

For liver CE, successful treatment results is achieved through three established percutaneous techniques The evaluation of percutaneous treatment outcomes should be based on the types of liver CE cysts, categorized into two groups according to the World Health Organization Informal Working Group on Echinococcosis (WHO-IWGE) classification: the first group includes CE1 and CE3a, while the second group encompasses CE2 and CE3b. Liver CE1 and CE3a cysts are treated using either Puncture, Aspiration, Injection, Reaspiration (PAIR) or catheterization techniques, with success rates reaching as high as 96% and recurrence rates as low as 4%. Modified catheterization (Mo-CAT) technique is a highly effective, safe, and successful option for treating CE2 and CE3b liver cysts. Although percutaneous interventional radiologic techniques have largely taken the place of surgery in treating patients with liver CE, radical surgery is the only cure option for AE. Partial hepatectomy or liver transplantation constitutes the primary therapeutic approach. Nevertheless, owing to the insidious nature of disease progression, diagnosis frequently occurs at an unresectable stage. In such instances, involvement of the biliary ducts and vascular structures, along with central necrosis of the lesion, may give rise to severe complications, including cholangitis, hepatic abscesses, portal hypertension, Budd-Chiari syndrome, biliary cirrhosis, and secondary infections, all of which can adversely affect both morbidity and mortality. Interventional radiologist is responsible for diagnosing the disease using radiological imaging methods (such as ultrasound, BT, and MRI), performing imaging-guided biopsy for definitive diagnosis, evaluating the resectability, managing both pre and postoperative biliary/vascular complications, and finally monitoring the disease progress.

Liver CE management: percutaneous techniques such as PAIR or standard catheterization are preferred as first choice for treating CE1 and CE3a cysts. CE2 and CE3b (Gharbi type III) cysts can be treated with Mo-CAT technique as an alternative to surgery. Liver AE management: radical surgery is curative, but interventional radiology provides critical palliative care and enhances the likelihood of future resectability or transplantation. Role of interventional radiology: interventional radiologists are essential in managing liver CE and AE, offering minimally invasive, image-guided solutions to improve patient outcomes.