Korean J Radiol.  2011 Oct;12(5):634-637. 10.3348/kjr.2011.12.5.634.

18F-FDG PET/CT in Primary AL Hepatic Amyloidosis Associated with Multiple Myeloma

• Son YM
• Choi JY
• Bak CH
• Cheon M
• Kim YE
• Lee KH
• Kim BT

• KMID: 1116451
• DOI: http://doi.org/10.3348/kjr.2011.12.5.634

Abstract

We report here on a rare case of primary AL hepatic amyloidosis associated with multiple myeloma in a 64-year-old woman. The patient was referred for evaluating her progressive jaundice and right upper quadrant pain. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) showed diffusely and markedly increased 18F-FDG uptake in the liver. Although there have been several case studies showing positive 18F-FDG uptake in pulmonary amyloidosis, to the best of our knowledge, the 18F-FDG PET/CT findings of hepatic amyloidosis or primary hepatic amyloidosis associated with multiple myeloma have not been reported previously.

Keyword

Amyloidosis; Multiple Myeloma; Liver; 18F-FDG PET

MeSH Terms

Amyloidosis/complications/pathology/*radionuclide imaging
Biopsy, Needle
Female
Fluorodeoxyglucose F18/*diagnostic use
Humans
Liver/pathology
Liver Diseases/complications/pathology/*radionuclide imaging
Middle Aged
Multiple Myeloma/*complications
*Positron-Emission Tomography and Computed Tomography
Radiopharmaceuticals/*diagnostic use

Figure

• 

  Fig. 1 Abdominal CT and PET/CT image of 64-year-old female patient with primary AL hepatic amyloidosis. A. Precontrast phase scan shows mild hepatomegaly with decreased attenuation of liver (attenuation value of hepatic parenchyma is 44 HU). B. Arterial phase scan shows heterogeneous enhancement with low-density lesions in periportal areas (arrows). C. Portal phase CT scan shows homogeneous enhancement of liver (91 HU) with focal hypoattenuating areas (78 HU) (arrow). D, E. Maximum intensity projection (D) and transverse fusion 18F-FDG PET/CT images (E) of primary AL hepatic amyloidosis patient. There was marked diffusely increased 18F-FDG uptake in enlarged liver (SUVmax = 7.2, SUVave = 4.1). In addition, high 18F-FDG uptake in bilateral adrenal glands was observed without mass, which suggested benign hyperplasia. F, G. In Biopsy specimens, there was amorphous eosinophilic material in liver parenchyma (F, Hematoxylin & Eosin staining, × 100), which was stained orange-red by Congo red (G, × 200), and this was consistent with amyloidosis.

Reference

1. Scott PP, Scott WW Jr, Siegelman SS. Amyloidosis: an overview. Semin Roentgenol. 1986. 21:103–112.

2. Gertz MA, Kyle RA. Hepatic amyloidosis: clinical appraisal in 77 patients. Hepatology. 1997. 25:118–121.

3. Yamamoto T, Maeda N, Kawasaki H. Hepatic failure in a case of multiple myeloma-associated amyloidosis (kappa-AL). J Gastroenterol. 1995. 30:393–397.

4. Okabe M, Choi GH, Kudo M, Nakaya H, Kishimoto A, Suzuki H, et al. Hepatic failure due to myeloma-associated amyloidosis. J Gastroenterol. 1998. 33:926–927.

5. Cross TJ, Wendon JA, Quaglia A, Salisbury JR, Heneghan MA, Harrison PM. Myeloma associated amyloidosis presenting as subacute liver failure. Postgrad Med J. 2006. 82:e13.

6. Seo JH, Lee SW, Ahn BC, Lee J. Pulmonary amyloidosis mimicking multiple metastatic lesions on F-18 FDG PET/CT. Lung Cancer. 2010. 67:376–379.

7. Grubstein A, Shitrit D, Sapir EE, Cohen M, Kramer MR. Pulmonary amyloidosis: detection with PET-CT. Clin Nucl Med. 2005. 30:420–421.

8. Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol. 1995. 32:45–59.

9. Vela-Ojeda J, Garcia-Ruiz Esparza MA, Padilla-Gonzalez Y, Sanchez-Cortes E, Garcia-Chavez J, Montiel-Cervantes L, et al. Multiple myeloma-associated amyloidosis is an independent high-risk prognostic factor. Ann Hematol. 2009. 88:59–66.

10. Kim SH, Han JK, Lee KH, Won HJ, Kim KW, Kim JS, et al. Abdominal amyloidosis: spectrum of radiological findings. Clin Radiol. 2003. 58:610–620.

11. Urban BA, Fishman EK, Goldman SM, Scott WW Jr, Jones B, Humphrey RL, et al. CT evaluation of amyloidosis: spectrum of disease. Radiographics. 1993. 13:1295–1308.

12. Benson L, Hemmingsson A, Ericsson A, Jung B, Sperber G, Thuomas KA, et al. Magnetic resonance imaging in primary amyloidosis. Acta Radiol. 1987. 28:13–15.

13. Ohta H, Endo K, Kanoh T, Konishi J, Kotoura H. Technetium-99m (V) DMSA uptake in amyloidosis. J Nucl Med. 1989. 30:2049–2052.

14. Barai S, Bandopadhayaya GP, Rathi M, Singh NG. Accumulation of Tc99m-DMSA-3 in the spleen in a case of multiple myeloma with associated amyloidosis. J Postgrad Med. 2005. 51:119–121.