Innovation for the Management of Echinococcosis March 27, 2014 Besançon, France

1. Acoustic Structure Quantification (ASQ): A New Tool in the Sonographic Diagnosis of Liver Lesions in Hepatic Alveolar Echinococcosis Innovation for the Management of Echinococcosis March 27, 2014 Besançon, France Tanja Kaltenbach, Dr. Tilmann Gräter, University Hospital UIm Germany

2. Methods Patients • 24 patients (13 women, 11 men) • mean age 52 years (16 - 85 years) • mean disease duration 68 months (1– 334 months) • diagnostically confirmed HAE liver lesion(s) • fasting at least 6 hours Examinations • Comparative ASQ examination of HAE liver lesions and of healthy liver tissue was performed with Toshiba Aplio 500 • Maximum size of lesions was measured in B-mode and in ASQ mode • ASQ videos were stored as raw data and used for quantitative analysis with ASQ software • ASQ parameters Mode, Average, Standard Deviation and FD-Ratio of lesions and of healthy tissue were compared

3. Methods Quantitative ASQ examination Example of placing four oval ROIs of similar size in a HAE lesion. Example of placing four ROIs in healthy liver parenchyma on level with the lesion.

4. Results • Subjectively, parasitic tumors in HAE appear more prominent in color-coded ASQ imaging • lesions’ size measured in ASQ mode does not differ from size measured in B-mode • Median FD-ratio of lesions was 3 (0.1 to 3), compared with 0.5 (0.1 to 1.8) in healthy liver (p < 0.0001) • Comparison of other ASQ parameters shows highly significantresults

5. Conclusion • Qualitative and quantitative ASQ is a practical and useful method to detect structural changes of liver parenchyma in HAE • FD-ratio can be considered a representative and practical ASQ parameter indicating tissue alterations in infested parenchyma • If lesion-specific ASQ reference values ​​can be defined in future long-term-studies, ASQ technology could provide additional information for follow up examinations of HAE liver lesions