Table 4.

Imaging features of hepatic alveolar echinococcosis and common mimics

Modality		Hepatic alveolar echinococosis	Hydatid cyst	Cystadenoma/cystadenoca	Cholangioca
Gross pathology		Poorly marginated infiltrative mass with frequent vascular, biliary and contiguous organ involvement	Well defined cystic lesion	Multilocular cyst with thick septae and mural nodules ± Ca+2	Irregular infiltrative hepatic mass
USG		Heterogeneously hyperechoic irregular mass with foci of calcification ± central necrosis	Well defined unilocular or multilocular cyst ± wall/matrix calcification	Thick walled cyst with septae and papillary projections	Heterogeneous infiltrative mass
CT	NCCT	Irregular heterogeneous density mass with calcification and cystic change	Well defined unilocular or multilocular cyst ± wall/matrix calcification	Hypodense mass with mural nodules	Hypodense irregular mass with capsular retraction and biliary dilatation
	CECT	No enhancement of mass; peripheral enhancement seen in some	No enhancement	Wall, septations and mural nodule enhancement	Rim or delayed heterogeneous enhancement
MRI	T1W	Hypointense	Hypointense	Hypointense to isointense	Hypointense
	T2W	Irregular mass with both hyper/hypointense components	Well defined hyperintense lesion with hypointense inner membrane	Hyperintense mass with septae/papillary nodules	Hyperintense to normal hepatic parenchyma
	T1W+C	No enhancement	No enhancement	Enhancement of wall/septations/mural nodules	Progressive enhancement with homogeneous/heterogeneous delayed enhancement
	DWI	Free diffusion	Free diffusion	Free diffusion; Wall/nodules restricted diffusion	Restricted diffusion

Cystadenoca – cystadenomcarcinoma, cholangioca – cholangiocarcinoma, Ca⁺² – calcification.