Ultrasound-Based Staging and Its Impact on Clinical Management of Hepatic Hydatid Cysts in an Endemic Setting: A Cross-Sectional Study in Eastern Afghanistan

Background: Hydatid disease, caused by Echinococcus granulosus, remains a significant public health concern in endemic regions. This study aimed to evaluate the role of ultrasound in the diagnosis, staging, and clinical management of liver hydatid cysts in eastern city Jalalabad, Afghanistan. Method: A cross-sectional study was conducted between February and November 2024 among 159 patients diagnosed with liver hydatid cysts. Demographic, clinical, laboratory, and imaging data were collected. Cysts were classified according to the WHO Informal Working Group on Echinococcosis (WHO-IWGE) and Gharbi systems. Ultrasound findings were compared with computed tomography (CT), and their association with treatment decisions was assessed. Result: Most patients were female (57.2%), aged 20–39 years, and from rural areas (80.5%). Common exposure-related factors included poor hygiene, dog ownership, and consumption of raw vegetables. Ultrasound effectively identified cyst stages and guided management decisions, with a significant association between WHO staging and treatment modality (χ² = 63.56, p < 0.001). There was almost perfect agreement between ultrasound and CT in cyst classification (Cohen’s κ > 0.9), although CT provided additional anatomical details in selected cases. Conclusion: Ultrasound is an accessible, accurate, and reliable tool for the diagnosis, staging, and management of liver hydatid cysts. In resource-limited settings, it serves as the primary imaging modality for guiding clinical decision-making, with CT reserved for complex or uncertain cases.