ArticleInsights into imaging2026
From fluid loss to calcification: MRI and CT matrix features in cystic echinococcosis.
Article in Insights into imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo characterize MRI matrix signal and CT calcification patterns across WHO-IWGE stages, compare them with lesion mimicking cystic echinococcosis (CE), and derive an MRI-based subclassification for inactive cysts. MATERIALS AND
methodsThis retrospective multicenter study included 105 patients (174 CE cysts) imaged between 2012 and 2024, plus 30 mimickers. Inclusion required axial T1-weighted imaging with chemical-shift in-phase/opposed-phase acquisitions and at least two T2-weighted sequences. Two radiologists independently reviewed all examinations, and a consensus was reached. Cysts were classified as inactive if no free-fluid T2 hypersignal was present on index MRI and corroborated by follow-up imaging and/or adjunct ultrasound in equivocal cases. Diagnostic performance indices were calculated to identify inactivity.
resultsFatty T1 hyperintensity was more frequent in inactive than active/transitional cysts (20/97 (21%) vs 2/77 (3%); p < 0.001). The "matrix flip-flop" sign was observed in 61/97 (63%) inactive cysts and in only two CE3b lesions (2/77 (3%); p < 0.001). Both signs showed high specificity for inactivity (75/77; 97.4%, 95% CI: 90.9-99.7). Matrix calcifications were associated with inactivity (46/97 (47%) vs 2/77 (3%); p < 0.001) and were rare among mimickers (2/30 (7%); p = 0.006). Homogeneous non-fatty T1 hyperintensity characterized mimickers (23/30 (77%) vs 10/174 (6%); p < 0.001). A three-tier inactive subclassification (early/intermediate/late) was derived from matrix T2 evolution.
conclusionMatrix MRI/CT features-particularly fatty foci and the matrix flip-flop sign-provide ancillary evidence of CE inactivity and help distinguish CE from mimickers. T2 signal supported an MRI-based framework for stage-adapted "watch-and-wait" follow-up. KEY POINTS: Question MRI features of cystic echinococcosis remain insufficiently studied, particularly matrix signal abnormalities that may affect diagnosis and viability assessment on routine imaging. Findings T1- and T2-weighted matrix CE cysts analysis identified fatty foci and the newly described matrix flip-flop sign as specific features of inactive cysts. Critical Relevance Assessment of underrecognized MRI and CT cyst-matrix features can help stage cystic echinococcosis, assess viability, and distinguish cystic echinococcosis cysts from mimickers.
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