Clinical and Preclinical Imaging of Hepatosplenic Schistosomiasis

Schistosomiasis, a neglected tropical disease, is a major cause of chronic morbidity and disability, and premature death. The hepatosplenic form of schistosomiasis is characterized by hepatosplenomegaly, liver fibrosis, portal hypertension, and esophageal varices, whose rupture may cause bleeding and death. We review currently available abdominal imaging modalities and describe their basic principles, strengths, weaknesses, and usefulness in the assessment of hepatosplenic schistosomiasis (HSS). Advanced imaging methods are presented that could be of interest for hepatosplenic schistosomiasis evaluation by yielding morphological, functional, and molecular parameters of disease progression. We also provide a comprehensive view of preclinical imaging studies and current research objectives such as parasite visualization in hosts, follow-up of the host's immune response, and development of noninvasive quantitative methods for liver fibrosis assessment. Liver fibrosis and portal hypertension in hepatosplenic schistosomiasis (HSS) may lead to variceal bleeding.Fibrogenesis in HSS differs from fibrogenesis of other etiology and requires specific and sensitive markers covering fibrosis heterogeneity. Currently no imaging markers are specific for HSS.Ultrasonography is the leading imaging modality for HSS diagnosis, but other diagnostic imaging techniques can quantify liver fibrosis.Quantitative markers of HSS (collagen, iron and calcium deposition, microvascular density and flow) became accessible by medical imaging modalities.Semiquantitative and quantitative imaging markers for the assessment of vascular and hemodynamic alterations constitute valuable markers for staging, prognosis, and treatment response.Preclinical imaging studies of HSS contribute to the development of clinically transferable markers sensitive to granulomatous inflammation and mild fibrosis.