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Novel imaging techniques using 18 F‐florbetapir PET/MRI can guide fascicular nerve biopsy in amyloid multiple mononeuropathy
Author(s) -
Shouman Kamal,
Broski Stephen M.,
Muchtar Eli,
Pendleton Courtney A.,
Johnson Geoffrey B.,
Tracy Jennifer,
Engelstad Janean K.,
Spinner Robert J.,
Dyck P. James B.
Publication year - 2021
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.27100
Subject(s) - mononeuropathy , medicine , amyloidosis , nerve biopsy , magnetic resonance imaging , biopsy , positron emission tomography , pathology , amyloid (mycology) , magnetic resonance neurography , radiology , peripheral neuropathy , endocrinology , diabetes mellitus
Background Multiple mononeuropathy is a rare presentation of primary (AL) amyloidosis and nerve biopsy is usually needed for diagnosis. Conventional imaging is useful to identify proximal nerve involvement but may be inadequate. We report a patient with multiple mononeuropathy whose presentation was suggestive of AL amyloid neuropathy and in whom repeated tissue biopsies were negative for amyloid (including two sensory nerves and one muscle). Methods The patient underwent magnetic resonance imaging (MRI) and whole body 18 F‐florbetapir positron emission tomography (PET)/MRI. Results Whole body 18 F‐florbetapir PET/MRI revealed abnormal low‐level florbetapir uptake in the right proximal tibial and peroneal nerves, which provided a target for a sciatic bifurcation fascicular nerve biopsy that was diagnostic of AL amyloidosis. Conclusions 18 F‐florbetapir PET/MRI imaging is a promising diagnostic tool for patients with suspected peripheral nerve amyloidosis (including multiple mononeuropathy) in whom conventional imaging and nerve and muscle biopsies miss the pathology.