What is the role of imaging studies in the workup of AA (inflammatory) amyloidosis?

Updated: Jan 08, 2021
  • Author: Jefferson R Roberts, MD; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Avoid intravenous pyelography in patients with suspected amyloidosis because exposure to contrast medium has been associated with more frequent renal failure in individuals with substantial proteinuria.

Ultrasonography is useful in establishing renal size; however, kidneys may be large, small, or normal in size in patients with renal amyloidosis.

Single-photon emission computed tomography (SPECT) may be useful because technetium occasionally binds to soft-tissue amyloid deposits. This was originally reported as an incidental finding. However, SPECT does not yield great sensitivity, and reports concerning its specificity of CT scanning have varied considerably. If results are positive, SPECT can be used to monitor gross progression of the deposition in a given organ.

MRI may have a role in amyloidosis diagnosis in the future, but, currently, no formal studies have reported its use in a large series of patients.

Iodine-123–labeled serum amyloid P (SAP) component scintigraphy has been used in centers in London and France to demonstrate the total body burden of amyloid and its disappearance after successful treatment of the primary disease. This test has been most useful in AA amyloidosis because the major sites of deposition (ie, liver, kidneys, spleen, and adrenal glands) are readily accessible to the imaging agent. However, this method is not available in the United States because the SAP is of human origin and cannot tolerate stringent viral inactivation. [42]


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