1Department of Radiology, Seoul National University College of Medicine, Korea. 2Department of Pathology, Seoul National University College of Medicine, Korea. 3Department of Parasitology, Catholic Medical College, Korea.
Published online: January 1, 2001.
ABSTRACT
PURPOSE: To determine the characteristic radiologic evolution pattern of hepatobiliary fascioliasis, we performed an experimental radiologic-pathologic correlative study in rabbits. MATERIALS & METHODS: After experimental ingestion of fluid containing metacercaria of Fasciola hepatica in 20 rabbits, serial ultrasound (US) and computed tomography (CT) were performed in 10 rabbits in odd weeks, and the other rabbits in even weeks. Cholangiography was also done with a total of nine liver specimens obtained in the third, fourth, fifth, sixth, 10th, 12th, and 14th weeks. Only one specimen, but three specimens in the 10th week, was obtained in each week. Serial radiologic findings were evaluated in correlation with the gross and microscopic findings. RESULTS: In parenchymal phase, US showed nonspecific variable echogenicity and CT was superior in detection and evaluation of the extent. In ductal phase, however, US demonstrated moving worms within the dilated ducts. The most common CT findings were subcapsular clustered or serpiginous areas of low attenuation in parenchymal phase and periportal low attenuation with biliary dilatation in ductal phase. Pathologically, the hepatic parenchymal lesion was a migratory tract of the flukes, which appeared as geographically-arranged eosinophilic granulomas. Periportal low attenuation was correlated with periductal Iymphangiectasia. Ductal changes such as biliary dilatation, papillary epithelial hyperplasia, and periductal fibrosis were observed predominantly in central bile ducts rather than peripheral small ducts. CONCLUSION: Subcapsular serpiginous areas of low attenuation which represent the migratory tracts are the characteristic CT findings of fascioliasis in parenchymal phase, and periportal low attenuation caused by periductal Iymphangiectasia is a suggestive finding in ductal phase The role of US is limited in parenchymal phase, but, very useful in ductal phase to demonstrate moving worms.
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