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Experimental Clonorchiasis in Dogs: CT Findings before and after Treatment¹

¹ From the Department of Radiology and the Institute of Radiation Medicine, Clinical Research Institute (K.H.L., J.K.H., C.J.Y., S.H.K., B.I.C.); Department of Parasitology (S.T.H.); and Department of Pathology (S.L.); Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-799, Korea. From the 2001 RSNA scientific assembly. Received January 4, 2002; revision requested March 1; final revision received October 22; accepted December 10. Address correspondence to S.T.H. (e-mail: hst@snu.ac.kr).

View larger version (17K): [in a new window]   Figure 1. Graph depicts the experimental design. Dogs were separated into two groups (groups A and B); each group consisted of five dogs. Dogs in group A were sacrificed 14 weeks after infection, and dogs in group B were treated with praziquantel and continued to undergo serial CT examinations until sacrifice at the 40th week. The numbers in the box and the vertical bars represent the times (in weeks after infection) at which CT examinations were performed; asterisks indicate the times at which fecal examinations were performed.

View larger version (17K): [in a new window]   Figure 2a. Graphs illustrate changes in CT findings during the follow-up period of 40 weeks in dogs infected with metacercariae of C sinensis. Ten dogs were followed up until the 13th week, five dogs were followed up through the 17th-25th weeks, and four dogs were followed up through the 30th-40th weeks. (a) Graph illustrates the calibers of the intrahepatic bile ducts. The connecting line indicates the change in the averaged calibers. Error bars represent standard errors of the mean. (b) Graph illustrates the degree of contrast enhancement of the walls of the bile ducts (finding b). (c) Graph illustrates the degree of THAD in the parenchyma adjacent to the dilated bile ducts (finding c). (d) Graph illustrates the identification of flukes at CT. Findings b and c were evaluated with a semiquantitative scale as absent (-) or minimal (+), mild (++), or severe (+++) in degree. After treatment (arrow), contrast enhancement of the ductal walls and THAD remained to a minimal or mild degree in two dogs, and flukes were identified at CT in one of these two dogs. # = dog with persistent ductal wall enhancement and THAD, * = dog with persistent ductal wall enhancement, THAD, and flukes.

View larger version (43K): [in a new window]   Figure 2b. Graphs illustrate changes in CT findings during the follow-up period of 40 weeks in dogs infected with metacercariae of C sinensis. Ten dogs were followed up until the 13th week, five dogs were followed up through the 17th-25th weeks, and four dogs were followed up through the 30th-40th weeks. (a) Graph illustrates the calibers of the intrahepatic bile ducts. The connecting line indicates the change in the averaged calibers. Error bars represent standard errors of the mean. (b) Graph illustrates the degree of contrast enhancement of the walls of the bile ducts (finding b). (c) Graph illustrates the degree of THAD in the parenchyma adjacent to the dilated bile ducts (finding c). (d) Graph illustrates the identification of flukes at CT. Findings b and c were evaluated with a semiquantitative scale as absent (-) or minimal (+), mild (++), or severe (+++) in degree. After treatment (arrow), contrast enhancement of the ductal walls and THAD remained to a minimal or mild degree in two dogs, and flukes were identified at CT in one of these two dogs. # = dog with persistent ductal wall enhancement and THAD, * = dog with persistent ductal wall enhancement, THAD, and flukes.

View larger version (46K): [in a new window]   Figure 2c. Graphs illustrate changes in CT findings during the follow-up period of 40 weeks in dogs infected with metacercariae of C sinensis. Ten dogs were followed up until the 13th week, five dogs were followed up through the 17th-25th weeks, and four dogs were followed up through the 30th-40th weeks. (a) Graph illustrates the calibers of the intrahepatic bile ducts. The connecting line indicates the change in the averaged calibers. Error bars represent standard errors of the mean. (b) Graph illustrates the degree of contrast enhancement of the walls of the bile ducts (finding b). (c) Graph illustrates the degree of THAD in the parenchyma adjacent to the dilated bile ducts (finding c). (d) Graph illustrates the identification of flukes at CT. Findings b and c were evaluated with a semiquantitative scale as absent (-) or minimal (+), mild (++), or severe (+++) in degree. After treatment (arrow), contrast enhancement of the ductal walls and THAD remained to a minimal or mild degree in two dogs, and flukes were identified at CT in one of these two dogs. # = dog with persistent ductal wall enhancement and THAD, * = dog with persistent ductal wall enhancement, THAD, and flukes.

View larger version (31K): [in a new window]   Figure 2d. Graphs illustrate changes in CT findings during the follow-up period of 40 weeks in dogs infected with metacercariae of C sinensis. Ten dogs were followed up until the 13th week, five dogs were followed up through the 17th-25th weeks, and four dogs were followed up through the 30th-40th weeks. (a) Graph illustrates the calibers of the intrahepatic bile ducts. The connecting line indicates the change in the averaged calibers. Error bars represent standard errors of the mean. (b) Graph illustrates the degree of contrast enhancement of the walls of the bile ducts (finding b). (c) Graph illustrates the degree of THAD in the parenchyma adjacent to the dilated bile ducts (finding c). (d) Graph illustrates the identification of flukes at CT. Findings b and c were evaluated with a semiquantitative scale as absent (-) or minimal (+), mild (++), or severe (+++) in degree. After treatment (arrow), contrast enhancement of the ductal walls and THAD remained to a minimal or mild degree in two dogs, and flukes were identified at CT in one of these two dogs. # = dog with persistent ductal wall enhancement and THAD, * = dog with persistent ductal wall enhancement, THAD, and flukes.

View larger version (138K): [in a new window]   Figure 3a. Transverse CT scans obtained in a dog in group A during (a) arterial and (b) portal phases at the 5th week after infection, and (c) photomicrograph of a liver specimen harvested at the 14th week. Note the dilatation of the peripheral intrahepatic bile ducts and their clublike blunt tips (arrow in a and b). Ringlike or tubular contrast enhancement of ductal walls and a wedge-shaped area of contrast enhancement in the adjacent parenchyma at the periphery of the liver are more visible on a. (c) In a section of the dilated bile ducts, periductal proliferation of arteries (arrows) and veins (arrowheads), as well as papillary proliferation of the bile duct epithelium and periductal inflammation, are seen. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (137K): [in a new window]   Figure 3b. Transverse CT scans obtained in a dog in group A during (a) arterial and (b) portal phases at the 5th week after infection, and (c) photomicrograph of a liver specimen harvested at the 14th week. Note the dilatation of the peripheral intrahepatic bile ducts and their clublike blunt tips (arrow in a and b). Ringlike or tubular contrast enhancement of ductal walls and a wedge-shaped area of contrast enhancement in the adjacent parenchyma at the periphery of the liver are more visible on a. (c) In a section of the dilated bile ducts, periductal proliferation of arteries (arrows) and veins (arrowheads), as well as papillary proliferation of the bile duct epithelium and periductal inflammation, are seen. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (162K): [in a new window]   Figure 3c. Transverse CT scans obtained in a dog in group A during (a) arterial and (b) portal phases at the 5th week after infection, and (c) photomicrograph of a liver specimen harvested at the 14th week. Note the dilatation of the peripheral intrahepatic bile ducts and their clublike blunt tips (arrow in a and b). Ringlike or tubular contrast enhancement of ductal walls and a wedge-shaped area of contrast enhancement in the adjacent parenchyma at the periphery of the liver are more visible on a. (c) In a section of the dilated bile ducts, periductal proliferation of arteries (arrows) and veins (arrowheads), as well as papillary proliferation of the bile duct epithelium and periductal inflammation, are seen. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (166K): [in a new window]   Figure 4a. Transverse CT scans obtained during the arterial phase in a dog in group B (a) 3, (b) 13, (c) 17, and (d) 40 weeks after infection, and (e) photomicrograph of liver specimen harvested at the 40th week. (a-d) Note gradual changes in the calibers of the dilated bile ducts (arrowheads in b-d), the degree of contrast enhancement of the ductal walls, and the THAD in the adjacent parenchyma during the follow-up period. Note that the THAD precedes the other findings at the 3rd week. (e) Histopathologic examination at the 40th week revealed the degeneration of periductal arteries (arrows), as well as the denudation of the ductal epithelium and decreased periductal inflammation. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (162K): [in a new window]   Figure 4b. Transverse CT scans obtained during the arterial phase in a dog in group B (a) 3, (b) 13, (c) 17, and (d) 40 weeks after infection, and (e) photomicrograph of liver specimen harvested at the 40th week. (a-d) Note gradual changes in the calibers of the dilated bile ducts (arrowheads in b-d), the degree of contrast enhancement of the ductal walls, and the THAD in the adjacent parenchyma during the follow-up period. Note that the THAD precedes the other findings at the 3rd week. (e) Histopathologic examination at the 40th week revealed the degeneration of periductal arteries (arrows), as well as the denudation of the ductal epithelium and decreased periductal inflammation. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (163K): [in a new window]   Figure 4c. Transverse CT scans obtained during the arterial phase in a dog in group B (a) 3, (b) 13, (c) 17, and (d) 40 weeks after infection, and (e) photomicrograph of liver specimen harvested at the 40th week. (a-d) Note gradual changes in the calibers of the dilated bile ducts (arrowheads in b-d), the degree of contrast enhancement of the ductal walls, and the THAD in the adjacent parenchyma during the follow-up period. Note that the THAD precedes the other findings at the 3rd week. (e) Histopathologic examination at the 40th week revealed the degeneration of periductal arteries (arrows), as well as the denudation of the ductal epithelium and decreased periductal inflammation. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (161K): [in a new window]   Figure 4d. Transverse CT scans obtained during the arterial phase in a dog in group B (a) 3, (b) 13, (c) 17, and (d) 40 weeks after infection, and (e) photomicrograph of liver specimen harvested at the 40th week. (a-d) Note gradual changes in the calibers of the dilated bile ducts (arrowheads in b-d), the degree of contrast enhancement of the ductal walls, and the THAD in the adjacent parenchyma during the follow-up period. Note that the THAD precedes the other findings at the 3rd week. (e) Histopathologic examination at the 40th week revealed the degeneration of periductal arteries (arrows), as well as the denudation of the ductal epithelium and decreased periductal inflammation. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (182K): [in a new window]   Figure 4e. Transverse CT scans obtained during the arterial phase in a dog in group B (a) 3, (b) 13, (c) 17, and (d) 40 weeks after infection, and (e) photomicrograph of liver specimen harvested at the 40th week. (a-d) Note gradual changes in the calibers of the dilated bile ducts (arrowheads in b-d), the degree of contrast enhancement of the ductal walls, and the THAD in the adjacent parenchyma during the follow-up period. Note that the THAD precedes the other findings at the 3rd week. (e) Histopathologic examination at the 40th week revealed the degeneration of periductal arteries (arrows), as well as the denudation of the ductal epithelium and decreased periductal inflammation. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (136K): [in a new window]   Figure 5a. Demonstration of flukes at CT in a dog in group A. (a) Transverse CT scan obtained during the portal phase at the 13th week shows nodular intraductal material (arrows) within the bile ducts. Note the inverted U shape (arrowheads) of one such collection of material. (b) Surface US image shows echogenic intraductal material (arrows) in the same area. (c) Section of the portal tract shows the enfolded posture of flukes (arrowheads) within the bile ducts. Note the enlargement of the arteries (solid arrows) as compared with the accompanying portal veins (open arrows). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (136K): [in a new window]   Figure 5b. Demonstration of flukes at CT in a dog in group A. (a) Transverse CT scan obtained during the portal phase at the 13th week shows nodular intraductal material (arrows) within the bile ducts. Note the inverted U shape (arrowheads) of one such collection of material. (b) Surface US image shows echogenic intraductal material (arrows) in the same area. (c) Section of the portal tract shows the enfolded posture of flukes (arrowheads) within the bile ducts. Note the enlargement of the arteries (solid arrows) as compared with the accompanying portal veins (open arrows). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (152K): [in a new window]   Figure 5c. Demonstration of flukes at CT in a dog in group A. (a) Transverse CT scan obtained during the portal phase at the 13th week shows nodular intraductal material (arrows) within the bile ducts. Note the inverted U shape (arrowheads) of one such collection of material. (b) Surface US image shows echogenic intraductal material (arrows) in the same area. (c) Section of the portal tract shows the enfolded posture of flukes (arrowheads) within the bile ducts. Note the enlargement of the arteries (solid arrows) as compared with the accompanying portal veins (open arrows). (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (173K): [in a new window]   Figure 6a. (a) Transverse CT scan obtained during the arterial phase 40 weeks after infection and (b) photomicrograph of liver specimen harvested at the 40th week from a dog in group B (the dog represented by the asterisks in Fig 2). (a) In this dog, unlike the dog in Figure 4, CT findings of infection in the acute stage remain to a mild degree. Note the dilatation of intrahepatic bile ducts (arrowheads), contrast enhancement of bile duct walls (arrow), and hyperattenuation in the parenchyma adjacent to the dilated ducts. (b) Histopathologic features of the active stage are seen in the corresponding areas. Note the periductal proliferation of arteries (arrowheads) and the papillary proliferation of the bile duct epithelium, as well as the partial denudation of the ductal epithelium (arrows). (Hematoxylin-eosin stain; original magnification, x40.) Pretreatment fecal examination and worm recovery during autopsy showed positive results (not shown) in this dog.

View larger version (168K): [in a new window]   Figure 6b. (a) Transverse CT scan obtained during the arterial phase 40 weeks after infection and (b) photomicrograph of liver specimen harvested at the 40th week from a dog in group B (the dog represented by the asterisks in Fig 2). (a) In this dog, unlike the dog in Figure 4, CT findings of infection in the acute stage remain to a mild degree. Note the dilatation of intrahepatic bile ducts (arrowheads), contrast enhancement of bile duct walls (arrow), and hyperattenuation in the parenchyma adjacent to the dilated ducts. (b) Histopathologic features of the active stage are seen in the corresponding areas. Note the periductal proliferation of arteries (arrowheads) and the papillary proliferation of the bile duct epithelium, as well as the partial denudation of the ductal epithelium (arrows). (Hematoxylin-eosin stain; original magnification, x40.) Pretreatment fecal examination and worm recovery during autopsy showed positive results (not shown) in this dog.

View larger version (154K): [in a new window]   Figure 7a. The formation of calcifications in a dog in group B. (a) Transverse CT scan obtained during the portal phase at the 13th week shows linear intraductal materials (arrowheads) within the bile ducts that represent the aggregates of flukes. (b) Transverse unenhanced CT scan obtained at the 34th week shows nodular or rod-shaped calcifications (arrows) scattered along the portal tracts. (c) Contact radiograph of the corresponding area shows microcalcifications. (d) Histopathologic examination revealed the formation of calcific spherules (arrows) along the walls of the bile ducts. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (139K): [in a new window]   Figure 7b. The formation of calcifications in a dog in group B. (a) Transverse CT scan obtained during the portal phase at the 13th week shows linear intraductal materials (arrowheads) within the bile ducts that represent the aggregates of flukes. (b) Transverse unenhanced CT scan obtained at the 34th week shows nodular or rod-shaped calcifications (arrows) scattered along the portal tracts. (c) Contact radiograph of the corresponding area shows microcalcifications. (d) Histopathologic examination revealed the formation of calcific spherules (arrows) along the walls of the bile ducts. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (117K): [in a new window]   Figure 7c. The formation of calcifications in a dog in group B. (a) Transverse CT scan obtained during the portal phase at the 13th week shows linear intraductal materials (arrowheads) within the bile ducts that represent the aggregates of flukes. (b) Transverse unenhanced CT scan obtained at the 34th week shows nodular or rod-shaped calcifications (arrows) scattered along the portal tracts. (c) Contact radiograph of the corresponding area shows microcalcifications. (d) Histopathologic examination revealed the formation of calcific spherules (arrows) along the walls of the bile ducts. (Hematoxylin-eosin stain; original magnification, x40.)

View larger version (141K): [in a new window]   Figure 7d. The formation of calcifications in a dog in group B. (a) Transverse CT scan obtained during the portal phase at the 13th week shows linear intraductal materials (arrowheads) within the bile ducts that represent the aggregates of flukes. (b) Transverse unenhanced CT scan obtained at the 34th week shows nodular or rod-shaped calcifications (arrows) scattered along the portal tracts. (c) Contact radiograph of the corresponding area shows microcalcifications. (d) Histopathologic examination revealed the formation of calcific spherules (arrows) along the walls of the bile ducts. (Hematoxylin-eosin stain; original magnification, x40.)