Measurement of liver and spleen interstitial volume in patients with systemic amyloid light-chain amyloidosis using equilibrium contrast CT
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To investigate equilibrium contrast-enhanced CT (EQ-CT) measurement of extracellular volume fraction (ECV) in patients with systemic amyloid light-chain (AL) amyloidosis, testing the hypothesis that ECV becomes elevated in the liver and spleen and ECV correlates with other estimates of organ amyloid burden.
26 patients with AL amyloidosis underwent EQ-CT, and ECV was measured in the liver and spleen. Patients also underwent serum amyloid P (SAP) component scintigraphy with grading of liver and spleen involvement. Mann–Whitney U test was used to test for a difference between patients with amyloid deposition (SAP grade 1–3) and those without (SAP grade 0). Variation in ECV across SAP grades was assessed using the Kruskal–Wallis test and association between ECV and SAP grades with Spearman correlation.
Mean ECV in the spleen and liver was significantly greater (p < 0.0005) in amyloidotic organs (SAP grade 1–3) [spleen, liver: 0.430, 0.375] compared with healthy tissues [spleen, liver: 0.304, 0.269]. ECV increased with increasing amyloid burden, showing positive correlation with SAP grade in both the liver (r = 0.758) and spleen (r = 0.867).
In patients with systemic AL amyloidosis, EQ-CT can demonstrate increased spleen and liver ECV, which is associated with amyloid disease burden.
KeywordsTomography X-ray computed Contrast media Amyloidosis Radiographic image interpretation Computer assisted Extracellular space
- AL amyloidosis
Systemic amyloid light-chain amyloidosis
Equilibrium contrast-enhanced computed tomography
Equilibrium contrast-enhanced magnetic resonance imaging
Equilibrium contrast cardiac MRI
Extracellular volume fraction
Serum amyloid P
We gratefully acknowledge the contributions of CT radiographers Elaine Atkins and Preeya Patel at University College London Hospital, David Edwards at the Royal Free Hospital, and Toshiba’s CT specialists Mark Condron and Tristan Lawton. TA Treibel and S Bandula are supported by Doctoral Research Fellowships from NIHR, UK (NIHR-DRF-2013-06-102/NIHR-DRF-2011-04-008). S Taylor is an NIHR senior investigator. The majority of this work was undertaken at University College London Hospital and University College London, which receive a proportion of funding from the NIHR Biomedical Research Centre funding scheme.
Compliance with ethical standards
This study has received funding from the National Amyloid Centre to cover scanning costs.
Conflict of interest
The authors declare that they have no conflict of interest.
Institutional Review Board approval was obtained. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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