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Alveolar Echinococcosis: MR Findings in the Liver¹

¹ From the Department of Radiology (Y.K., T.S., H.E., T.N., K.M) and First Department of Surgery (N.S., S.T.), Hokkaido University School of Medicine, N15, W7, Kitaku, Sapporo, 060-8638, Japan; and Department of Radiology, Hakodate Chuo Hospital, Japan (N.F.). From the 2001 RSNA scientific assembly. Received March 20, 2002; revision requested June 6; revision received September 19; accepted November 18. Address correspondence to Y.K. (e-mail: ykodama@radi.med.hokudai.ac.jp).

View larger version (40K): [in a new window]   Figure 1. Schematic shows classification scheme of MR findings of alveolar echinococcosis in the liver.

View larger version (123K): [in a new window]   Figure 2a. Transverse MR images show type 1 lesions. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows clustered small cysts in segments 5 (arrow) and 4 (arrowhead). (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows low signal intensity of the lesions (arrow and arrowhead). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement in small round cysts (arrow and arrowhead) and slightly enhanced adjacent liver parenchyma.

View larger version (105K): [in a new window]   Figure 2b. Transverse MR images show type 1 lesions. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows clustered small cysts in segments 5 (arrow) and 4 (arrowhead). (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows low signal intensity of the lesions (arrow and arrowhead). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement in small round cysts (arrow and arrowhead) and slightly enhanced adjacent liver parenchyma.

View larger version (109K): [in a new window]   Figure 2c. Transverse MR images show type 1 lesions. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows clustered small cysts in segments 5 (arrow) and 4 (arrowhead). (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows low signal intensity of the lesions (arrow and arrowhead). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement in small round cysts (arrow and arrowhead) and slightly enhanced adjacent liver parenchyma.

View larger version (127K): [in a new window]   Figure 3a. Transverse MR images show a type 2 lesion. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows an isointense solid component with peripheral small cysts (arrowheads). (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence depicts low signal intensity of the lesion (arrow). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement in the lesion (arrow).

View larger version (114K): [in a new window]   Figure 3b. Transverse MR images show a type 2 lesion. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows an isointense solid component with peripheral small cysts (arrowheads). (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence depicts low signal intensity of the lesion (arrow). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement in the lesion (arrow).

View larger version (110K): [in a new window]   Figure 3c. Transverse MR images show a type 2 lesion. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows an isointense solid component with peripheral small cysts (arrowheads). (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence depicts low signal intensity of the lesion (arrow). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement in the lesion (arrow).

View larger version (130K): [in a new window]   Figure 4a. Transverse MR images show type 3 lesions. (a) T2-weighted spin-echo (2,300/90) image shows an isointense solid component (arrow) with multiple small cysts (small arrowheads) and large irregular cysts (large arrowheads). (b) T1-weighted spin-echo (650/15; flip angle, 30°) image shows a large area with low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted spin-echo (650/15; flip angle, 30°) image shows heterogeneous enhancement (arrowheads) at the peripheral area of the mass.

View larger version (113K): [in a new window]   Figure 4b. Transverse MR images show type 3 lesions. (a) T2-weighted spin-echo (2,300/90) image shows an isointense solid component (arrow) with multiple small cysts (small arrowheads) and large irregular cysts (large arrowheads). (b) T1-weighted spin-echo (650/15; flip angle, 30°) image shows a large area with low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted spin-echo (650/15; flip angle, 30°) image shows heterogeneous enhancement (arrowheads) at the peripheral area of the mass.

View larger version (120K): [in a new window]   Figure 4c. Transverse MR images show type 3 lesions. (a) T2-weighted spin-echo (2,300/90) image shows an isointense solid component (arrow) with multiple small cysts (small arrowheads) and large irregular cysts (large arrowheads). (b) T1-weighted spin-echo (650/15; flip angle, 30°) image shows a large area with low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted spin-echo (650/15; flip angle, 30°) image shows heterogeneous enhancement (arrowheads) at the peripheral area of the mass.

View larger version (120K): [in a new window]   Figure 5a. Transverse MR images show a type 4 lesion. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows a lesion with low signal intensity (arrowheads) without a cystic component in segment 5. (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows the lesion as an area of low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement of the lesion (arrowheads).

View larger version (126K): [in a new window]   Figure 5b. Transverse MR images show a type 4 lesion. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows a lesion with low signal intensity (arrowheads) without a cystic component in segment 5. (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows the lesion as an area of low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement of the lesion (arrowheads).

View larger version (122K): [in a new window]   Figure 5c. Transverse MR images show a type 4 lesion. (a) T2-weighted (4.4/90) image obtained with half-Fourier rapid acquisition with relaxation enhancement shows a lesion with low signal intensity (arrowheads) without a cystic component in segment 5. (b) T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows the lesion as an area of low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted (120/4; flip angle, 30°) image obtained with a fast low-angle shot sequence shows no enhancement of the lesion (arrowheads).

View larger version (175K): [in a new window]   Figure 6a. Transverse MR images show a type 5 lesion. (a) T2-weighted spin-echo (2,300/90) image shows a prominent lesion (arrowheads) with high signal intensity, which matches that of cerebrospinal fluid. This is an example of a cystic component without a solid component. (b) T1-weighted spin-echo (650/15) image shows a lesion with low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted spin-echo (650/15) image shows no enhancement of the lesion (arrowheads).

View larger version (178K): [in a new window]   Figure 6b. Transverse MR images show a type 5 lesion. (a) T2-weighted spin-echo (2,300/90) image shows a prominent lesion (arrowheads) with high signal intensity, which matches that of cerebrospinal fluid. This is an example of a cystic component without a solid component. (b) T1-weighted spin-echo (650/15) image shows a lesion with low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted spin-echo (650/15) image shows no enhancement of the lesion (arrowheads).

View larger version (179K): [in a new window]   Figure 6c. Transverse MR images show a type 5 lesion. (a) T2-weighted spin-echo (2,300/90) image shows a prominent lesion (arrowheads) with high signal intensity, which matches that of cerebrospinal fluid. This is an example of a cystic component without a solid component. (b) T1-weighted spin-echo (650/15) image shows a lesion with low signal intensity (arrowheads). (c) Contrast-enhanced T1-weighted spin-echo (650/15) image shows no enhancement of the lesion (arrowheads).