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Imaging Techniques in the Diagnosis of Dialysis‐Related Amyloidosis
Author(s) -
Ketteler Markus,
Koch Karl Martin,
Floege Jürgen
Publication year - 2001
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1046/j.1525-139x.2001.00025.x
Subject(s) - medicine , amyloidosis , nuclear medicine , amyloid (mycology) , beta 2 microglobulin , beta (programming language) , magnetic resonance imaging , hemodialysis , technetium , pathology , radiology , computer science , programming language
β 2 ‐microglobulin amyloidosis (Aβ 2 M) is a major determinant of morbidity in patients on dialysis treatment. Symptoms of Aβ 2 M amyloid are mainly related to (peri‐)articular amyloid deposition. Imaging techniques [i.e., joint ultrasonography, X‐ray, computed tomography (CT), or magnetic resonance imaging (MRI) findings], as well as conventional bone scans, are helpful in the screening of local lesions but are relatively nonspecific and/or not sensitive enough. Scintigraphic techniques using radiolabeled serum amyloid P component (SAP) or the radiolabeled Aβ 2 M precursor protein, β 2 M, generate more specific results. Aβ 2 M deposits have been visualized in several long‐term hemodialysis patients by using 123 I‐labeled SAP. However, this scan did not show tracer accumulation in some frequently involved sites such as hips or shoulders, and frequently labeled the spleen, which is usually spared from Aβ 2 M deposits. Improvements in technical sensitivity and specificity could be achieved by scanning with 131 I‐labeled β 2 M: this technique detected tracer accumulations corresponding to the typical distribution pattern of Aβ 2 M. Further, both the radiation exposure and the optical resolution of this latter scan have been refined by substituting 111 In for 131 I. In a final step we generated recombinant human β 2 M (rhβ 2 M). While 111 In rhβ 2 M again failed to show significant tracer accumulation over joint regions in patients on short‐term hemodialysis without evidence of Aβ 2 M, local tracer accumulations similar to those observed with natural, 111 In‐labeled β 2 M could be demonstrated in long‐term hemodialysis patients with evidence of Aβ 2 M. In conclusion, scintigraphy for Aβ 2 M with 111 In‐labeled rhβ 2 M provides a homogeneous and safe recombinant protein source and represents a suitable detection method of β 2 M amyloid deposits in dialysis patients.