Diagnostic pearls and pitfalls in the radiologic evaluation of hepatic alveolar echinococcosis

Hepatic alveolar echinococcosis is a tumor-mimicking parasitic disease characterized by infiltrative hepatic involvement and substantial radiologic overlap with malignancy. Predominantly solid morphology, pseudo-capsular margins, and deceptive enhancement patterns frequently contribute to misclassification as primary or secondary liver cancer. Intralesional calcifications on non-contrast computed tomography (CT) and the absence of true arterial phase hyperenhancement on CT and magnetic resonance imaging represent important diagnostic clues. Diffusion-weighted imaging may further aid characterization, although overlap with malignant lesions persists. Accurate interpretation requires systematic multimodality imaging assessment integrated with clinical and serologic context. Increased awareness of characteristic imaging features and common pitfalls is essential to reduce diagnostic delay and prevent inappropriate oncologic management.