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Abdominal Radiology

, Volume 42, Issue 11, pp 2646–2651 | Cite as

Measurement of liver and spleen interstitial volume in patients with systemic amyloid light-chain amyloidosis using equilibrium contrast CT

  • Jason YeungEmail author
  • S. Sivarajan
  • T. A. Treibel
  • S. Rosmini
  • M. Fontana
  • J. D. Gillmore
  • P. N. Hawkins
  • S. Punwani
  • J. C. Moon
  • S. A. Taylor
  • S. Bandula
Article

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

In patients with systemic AL amyloidosis, EQ-CT can demonstrate increased spleen and liver ECV, which is associated with amyloid disease burden.

Keywords

Tomography X-ray computed Contrast media Amyloidosis Radiographic image interpretation Computer assisted Extracellular space 

Abbreviations

AL amyloidosis

Systemic amyloid light-chain amyloidosis

EQ-CT

Equilibrium contrast-enhanced computed tomography

EQ-MRI

Equilibrium contrast-enhanced magnetic resonance imaging

EQ-CMR

Equilibrium contrast cardiac MRI

ECV

Extracellular volume fraction

SAP

Serum amyloid P

Notes

Acknowledgements

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

Funding

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Gillmore JD, Hawkins PN (2013) Pathophysiology and treatment of systemic amyloidosis. Nat Rev Nephrol 9(10):574–586CrossRefPubMedGoogle Scholar
  2. 2.
    Sattianavagam PT, Hawkins PN, Gillmore JD (2009) Systemic amyloidosis and the gastrointestinal tract. Nat Rev Gastroenterol Hepatol 6(10):608–617CrossRefGoogle Scholar
  3. 3.
    Lovat LB, Persey MR, Madhoo S, Pepys MB, Hawkins P (1998) The liver in systemic amyloidosis: insights from 123I serum amyloid P component scintigraphy in 484 patients. Gut 42(5):727–734CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Monzawa S, Tsukamoto T, Omata K, et al. (2002) A Case with primary amyloidosis of the liver and spleen: radiologic findings. Eur J Radiol 41(3):237–241CrossRefPubMedGoogle Scholar
  5. 5.
    Sachchithanantham S, Wechalekar AD (2013) Imaging in systemic amyloidosis. Br Med Bull 107(1):41–56CrossRefPubMedGoogle Scholar
  6. 6.
    Georgiades CS, Neyman EG, Barish MA, Fishman EK (2004) Amyloidosis: review and CT manifestations. Radiographics 24(2):405–416CrossRefPubMedGoogle Scholar
  7. 7.
    Bandula S, White SJ, Flett AS, et al. (2013) Measurement of myocardial extracellular volume fraction by using equilibrium contrast-enhanced CT: validation against histologic findings. Radiology 269(2):396–403CrossRefPubMedGoogle Scholar
  8. 8.
    Banypersad SM, Sado DM, Flett AS, et al. (2013) Quantification of myocardial extracellular volume fraction in systemic AL amyloidosis: an equilibrium contrast cardiovascular magnetic resonance study. Circulation 6(1):34–39PubMedGoogle Scholar
  9. 9.
    Treibel TA, Bandula S, Fontana M, et al. (2015) Extracellular volume quantification by dynamic equilibrium cardiac computed tomography in cardiac amyloidosis. J Cardiovasc Comput Tomogr 9(6):585–592CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Bandula S, Punwani S, Rosenberg WM, et al. (2015) Equilibrium contrast-enhanced CT imaging to evaluate hepatic fibrosis: initial validation by comparison with histopathologic sampling. Radiology 275(1):136–143CrossRefPubMedGoogle Scholar
  11. 11.
    Varenika V, Fu Y, Maher JJ, et al. (2013) Hepatic fibrosis: evaluation with semiquantitative contrast-enhanced CT. Radiology 266(1):151–158CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Zissen MH, Wang ZJ, Yee J, et al. (2013) Contrast-enhanced CT quantification of hepatic fractional extraceullar space: correlation with diffuse liver disease severity. Am J Roentgenol 201(6):1204–1210CrossRefGoogle Scholar
  13. 13.
    Yoon JH, Lee JM, Klotz E, et al. (2015) Estimation of hepatic extracellular volume fraction using multiphasic liver computed tomography for hepatic fibrosis grading. Invest Radiol 50(4):290–296CrossRefPubMedGoogle Scholar
  14. 14.
    Bandula S, Banypersad SM, Sado DM, et al. (2013) Measurement of tissue interstitial volume in healthy patients and those with amyloidosis with equilibrium contrast-enhanced MR imaging. Radiology 268(3):858–864CrossRefPubMedGoogle Scholar
  15. 15.
    Hawkins PN, Lavender JP, Pepys MB (1990) Evaluation of systemic amyloidosis by scintigraphy with 123 I-labelled serum amyloid P component. N Engl J Med 25(7):709–713Google Scholar
  16. 16.
    Rydh A, Suhr O, Hietala SO, et al. (1998) Serum amyloid P component scintigraphy in familial amyloid polyneuropathy: regression of visceral amyloid following liver transplantation. Eur J Nucl Med 25(7):2197–2215Google Scholar
  17. 17.
    Hazenburg BP, van Rijswijk MH, Piers DA, et al. (2006) Diagnostic performance of 123I-labeled serum amyloid P component scintigraphy in patients with amyloidosis. Am J Med 119(4):355Google Scholar
  18. 18.
    White SK, Sado DM, Fontana M, et al. (2013) T1 mapping for myocardial extracellular volume measurement by CMR: bolus only versus primed infusion technique. JACC Cardiovasc Imaging 6(9):955–962CrossRefPubMedGoogle Scholar
  19. 19.
    Chen B, Marin D, Richard S, et al. (2013) Precision of iodine quantification in hepatic CT: effects of iterative reconstruction with various imaging parameters. Am J Roentgenol. 200(5):W475–W482CrossRefGoogle Scholar
  20. 20.
    Shuman WP, Green DE, Busey JM, et al. (2013) Model-based Iterative reconstruction versus adaptive statistical iterative reconstruction and filtered back projection in liver 64-MDCT: focal lesion detection, lesion conspicuity and image noise. AM J Roentgenol 200(5):1071–1076CrossRefGoogle Scholar
  21. 21.
    Kase KR, Strom DJ, Thomadsen BR, Suleiman OH, Quinn DM, Miller KL (2009) National Council on Radiation Protection Report no. 160, Ionizing Radiation Exposure of the Population of the United States. National Council on Radiation Protection and MeasurementsGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Centre for Medical ImagingUniversity College LondonLondonUK
  2. 2.Institute of Cardiovascular ScienceUniversity College LondonLondonUK
  3. 3.Barts Heart CentreSt Bartholomew’s HospitalLondonUK
  4. 4.National Amyloidosis CentreUniversity College LondonLondonUK

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