Clinical research studyDiagnostic Performance of 123I-Labeled Serum Amyloid P Component Scintigraphy in Patients with Amyloidosis
Section snippets
Patients
All 219 consecutive patients with histologically proven amyloidosis who were evaluated at Groningen University Hospital, a tertiary referral center, from February 1990 until December 2003 were prospectively screened for the study. Patients were classified to have systemic amyloidosis of the AA, AL, or hereditary ATTR type, or localized amyloidosis.10
Amyloid was diagnosed in all patients by the presence of typical apple-green birefringence in polarized light in a tissue specimen stained with
All Patients
A total of 189 patients were included: 60 with AA, 80 with AL (21 kappa and 59 lambda), and 27 with hereditary ATTR types of systemic amyloidosis, whereas 22 had localized disease. Nineteen patients without amyloid and one healthy person served as controls. Patient characteristics are shown in Table 2.
Positive uptake was seen in 54 AA, 72 AL, and 13 ATTR patients, as shown in Table 3; abnormal images were also obtained in 3 patients with localized disease but in none of the controls. Thus,
Discussion
This study confirms that 123I-SAP scintigraphy is an effective noninvasive tool for diagnosis of systemic AA and AL amyloidosis, which provides additional information on the distribution and amount of amyloid in various visceral sites. Characteristic patterns of organ involvement can give a strong indication of amyloid fibril type, although substantial overlap between types does occur. The sensitivity of SAP scintigraphy is greatest for larger solid viscera, including the spleen, liver and
Acknowledgments
We would like to thank C. Th. Smit Sibinga, W. Tuuk Adriani, P.C. Limburg, and J. Bijzet for manufacturing SAP, and A.K. van Zanten, C. Harms, H. Pol, H. Nijnuis, and J.Boorsma for performing labeling studies and laboratory analysis. The “Dutch Arthritis Foundation” and the “Jan Kornelis de Cock Stichting” provided financial support for this study.
References (29)
- et al.
Prospective and serial study of primary amyloidosis with serum amyloid P component scintigraphyfrom diagnosis to prognosis
Am J Med
(1996) - et al.
Prognostication of survival using cardiac troponins and N-terminal pro-brain natriuretic peptide in patients with primary systemic amyloidosis undergoing peripheral blood stem cell transplantation
Blood
(2004) - et al.
Diagnostic radionuclide imaging of amyloidbiological targeting by circulating human serum amyloid P component
Lancet
(1988) - et al.
Amyloid load and clinical outcome in AA amyloidosis in relation to circulating concentration of serum amyloid A protein
Lancet
(2001) - et al.
Imaging of dialysis-related amyloid (AB-amyloid) deposits with 131-I-β2-microglobulin
Kidney Int
(1990) - et al.
Molecular mechanisms of amyloidosis
N Engl J Med
(2003) - et al.
The systemic amyloidoses
N Engl J Med
(1997) - et al.
Amyloid P componenta critical review
Amyloid
(1997) - et al.
Evaluation of systemic amyloidosis by scintigraphy with 123I-labeled serum amyloid P component
N Engl J Med
(1990) - et al.
Metabolic studies of radioiodinated serum amyloid P component in normal subjects and patients with systemic amyloidosis
J Clin Invest
(1990)