Unusual computed tomography findings in hepatic amyloidosis

Liver and Gastrointestinal Involvement: Update

The organs affected most commonly by AL amyloidosis are the kidneys and heart, however, liver and gastrointestinal (GI) tract are also commonly affected. Symptoms of GI amyloidosis often mimic those of other GI disorders; having a keen awareness of the need to evaluate for amyloidosis is critical in avoiding delay in diagnosis and intervention. GI and liver involvement is associated with significant complications, and challenges in symptomatic management. As with all AL-related organ disease, early systemic treatment can prevent progression of tissue damage and improve outcomes.

Splenic hypoperfusion as a sign of systemic amyloidosis

BACKGROUND

The spleen is frequently involved in systemic amyloidosis; however, the computed tomographic (CT) or magnetic resonance (MR) pattern of splenic amyloidosis is not sufficiently described in the literature. This study evaluated the contrast-enhanced CT and MR findings of the spleen in patients with systemic amyloidosis.

METHODS

Data were extracted by reviewing pathology and radiology department records of the teaching hospital of Naples over 10 years, from 1 January 1993 to 31 December 2002. Thirty-three patients with amyloidosis were identified, 10 of whom had a CT scan and two of whom had an MR study. The population-based study was composed of 12 patients with histologically proved amyloidosis who underwent contrast-enhanced CT or MR scan of the abdomen. The spleen and liver were evaluated for organ size and perfusion.

RESULTS

The spleen was hypoperfused in nine of 12 patients. Mild splenomegaly was present in only one case. Hepatomegaly was associated with markedly acute left lobe margin in nine patients and with rounded anterior profile of segments 3 and 4 in four patients. Moreover, a large area of low attenuation with indefinite geographic margins involving the right hepatic lobe was observed in three patients.

CONCLUSION

The finding of splenic hypoperfusion may be a marker of systemic amyloidosis, which represents a useful clue when clinical findings fail to suggest the proper diagnosis.

A case with primary amyloidosis of the liver and spleen: radiologic findings

A case with primary amyloidosis of the liver and spleen is presented. In the liver, ultrasonography showed heterogeneous echogenicity. Portal phase CT showed heterogeneous enhancement, and delayed phase CT showed delayed enhancement with focal hypoattenuating areas. Bone scintigraphy showed diffuse accumulation. In the spleen, arterial phase CT showed the lack of parenchymal enhancement, and T2-weighted MR imaging showed decreased signal intensity. The combination of imaging findings of the liver and spleen was suggestive of amyloidosis.

Diffuse liver disease

During the last decade, the role of the radiologist in evaluating patients with diffuse liver disease has increasingly expanded. In many cases, the management choices for the hepatologist in the imaging work-up of a patient with suspicion of a diffuse liver disease have significantly widened. In some instances, imaging may point directly to the diagnosis; in many instances, imaging helps narrow the differential diagnosis or is crucial in the follow-up of patients. Although some rare entities still have nonspecific radiologic features, the imaging pattern, in combination with appropriate clinical information, may provide the most likely diagnosis.

Imaging of diffuse liver disease

Imaging can play an important role in the diagnosis and planning of treatment for patients with diffuse liver disease. In certain entities, such as iron overload disorders, fatty change, Budd-Chiari syndrome, and schistosomiasis, the imaging findings are characteristic and diagnostic. In others, the findings are less specific, but imaging still has utility in assessment for associated changes of cirrhosis and portal hypertension. In either case, familiarity with these diffuse hepatic diseases and their expected imaging findings enables an organized and thoughtful assessment, with careful attention paid to the key diagnostic features and the important sequlae, such as portal hypertension and the development of HCC.