Skip to main content
SpringerLink
Log in

Amyloidosis of the liver on shear wave elastography: case report and review of literature

  • Case Report
  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

Amyloidosis is extremely rare, with an estimated 2225 new US cases reported annually. Signs and symptoms of the disease are subtle and imaging findings are not pathognomonic. Currently, diagnosis requires biopsy to demonstrate the deposition of amyloid. Elastography is a new imaging modality that evaluates tissue elasticity. It has shown to have efficacy in characterizing thyroid nodules, detecting prostate cancer, and staging liver fibrosis. We present a case of hepatic amyloidosis in a 51-year-old male that demonstrates significantly increased stiffness with a median value of 99.1 kPa (range 25.7–188.9 kPa) on shear-wave elastography (SWE) imaging, which is significantly higher than the cut-off range reported for cirrhosis on SWE (10.4–11.5 kPa). This finding raises the possibility that elastographic imaging may be sensitive to tissue mechanical changes induced by amyloid deposition.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Kyle RA, Linos A, Beard CM, et al. (1992) Incidence and natural history of primary systemic amyloidosis in Olmsted County, Minnesota, 1950 through 1989. Blood 79:1817–1822

    CAS  PubMed  Google Scholar 

  2. Loizos S, Shiakalli Chrysa T, Christos GS (2014) Amyloidosis: review and imaging findings. Semin Ultrasound CT MRI 35:225–239

    Article  Google Scholar 

  3. Scott PP, Scott WW, Siegelman SS (1986) Amyloidosis: an overview. Semin Roentgenol 21:103–112

    Article  CAS  PubMed  Google Scholar 

  4. Buppajarntham S, Kue-A-Pai P (2014) Extensive loculated ascites in hepatic amyloidosis. N Am J Med Sci 6:346–348

    Article  PubMed Central  PubMed  Google Scholar 

  5. Lovat L, Persey M, Madhoo S, Pepys M, Hawkins P (1998) The liver in systemic amyloidosis: insights from I-123-serum amyloid P component scintigraphy. Gut 42:727–734

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Iwata T, Hoshii Y, Kawano H, et al. (1995) Hepatic amyloidosis in Japan: histological and morphometric analysis based on amyloid proteins. Hum Pathol 26:1148–1153

    Article  CAS  PubMed  Google Scholar 

  7. Brandt K, Cathcart ES, Cohen AS (1968) A clinical analysis of the course and prognosis of forty-two patients with amyloidosis. Am J Med 44:955–969

    Article  CAS  PubMed  Google Scholar 

  8. Levine RA (1962) Amyloid disease of the liver. Correlation of clinical, functional and morphologic features in forty-seven patients. Am J Med 33:349–357

    Article  CAS  PubMed  Google Scholar 

  9. Kyle RA, Bayrd ED (1975) Amyloidosis: review of 236 cases. Medicine (Baltimore) 54:271–299

    Article  CAS  Google Scholar 

  10. Shin YM (2011) Hepatic amyloidosis. Korean J Hepatol 17:80–83

    Article  PubMed Central  PubMed  Google Scholar 

  11. Kim S, Han J, Lee K, et al. (2003) Abdominal amyloidosis: spectrum of radiological findings. Clin Radiol 58:610–620

    Article  CAS  PubMed  Google Scholar 

  12. Mainenti PP, D`Agostino L, Soscia E, Romano M, Salvatore M (2003) Hepatic and splenic amyloidosis: dual-phase spiral CT findings. Abdom Imaging 28:688–690

    Article  CAS  PubMed  Google Scholar 

  13. Møller JM, Santoni-Rugiu E, Chabanova E, et al. (2007) Magnetic resonance imaging with liver-specific contrast agent in primary amyloidosis and intrahepatic cholestasis. Acta Radiol 48:145–149

    Article  PubMed  Google Scholar 

  14. DeWall RJ (2013) Ultrasound elastography: principles, techniques, and clinical applications. Crit Rev Biomed Eng 41:1–19

    Article  PubMed  Google Scholar 

  15. Sharma S (2014) Non-invasive diagnosis of advanced fibrosis and cirrhosis. World J Gastroenterol 20:16820

    Article  PubMed Central  PubMed  Google Scholar 

  16. Tsochatzis EA, Gurusamy KS, Ntaoula S, et al. (2011) Elastography for the diagnosis of severity of fibrosis in chronic liver disease: a meta-analysis of diagnostic accuracy. J Hepatol 54:650–659

    Article  CAS  PubMed  Google Scholar 

  17. Shi K, Fan Y, Pan Z, et al. (2013) Transient elastography: a meta-analysis of diagnostic accuracy in evaluation of portal hypertension in chronic liver disease. Liver Int 33:62–71

    Article  PubMed  Google Scholar 

  18. Chon YE, Choi EH, Song KJ, et al. (2012) Performance of transient elastography for the staging of liver fibrosis in patients with chronic hepatitis B: a meta-analysis. PLoS One 7:1–7

    Google Scholar 

  19. Castéra L, Vergniol J, Foucher J, et al. (2005) Prospective comparison of transient elastography, fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 128:343–350

    Article  PubMed  Google Scholar 

  20. Dhyani M, Anvari A, Samir AE (2015) Ultrasound elastography: liver. Abdom Imaging 40:698–708

    Article  PubMed  Google Scholar 

  21. Samir AE, Dhyani M, Vij A, et al. (2015) Shear-wave elastography for the estimation of liver fibrosis in chronic liver disease. Radiology . doi:10.1148/radiol.14140839

    Google Scholar 

  22. Samir AE, Dhyani M, Anvari A, et al. (2015) Share-wave elastography for the preoperative risk stratification of follicular-patterned lesions of the thyroid: diagnostic accuracy and optimal measurement plane. Radiology 7:141627

    Google Scholar 

  23. Kwak JY, Kim E-K (2014) Ultrasound elastography for thyroid nodules: recent advances. Ultrasonography (Seoul, Korea) 33:75–82

    Google Scholar 

  24. Anvari A, Barr RG, Dhyani M, Samir AE (2015) Clinical application of sonoelastography in thyroid, prostate, kidney, pancreas, and deep venous thrombosis. Abdom Imaging 40:709–722

    Article  PubMed  Google Scholar 

  25. Boehm K, Salomon G, Beyer B, et al. (2015) Shear wave elastography for localization of prostate cancer lesions and assessment of elasticity thresholds: implications for targeted biopsies and active surveillance protocols. J Urol 193:794–800

    Article  PubMed  Google Scholar 

  26. Ferraioli G, Tinelli C, Dal Bello B, et al. (2012) Accuracy of real-time shear wave elastography for assessing liver fibrosis in chronic hepatitis C: a pilot study. Hepatology 56:2125–2133

    Article  PubMed  Google Scholar 

  27. Sporea I, Bota S, Gradinaru-Taşcău O, Şirli R, Popescu A, Jurchiş A (2014) Which are the cut-off values of 2D-shear wave elastography (2D-SWE) liver stiffness measurements predicting different stages of liver fibrosis, considering transient elastography (TE) as the reference method? Eur J Radiol 83:118–122

    Article  Google Scholar 

  28. Poynard T, Ratziu V, Bedossa P (2000) Appropriateness of liver biopsy. Can J Gastroenterol 14:543–548

    CAS  PubMed  Google Scholar 

  29. Cadranel JF, Rufat P, Degos F (2000) Practices of liver biopsy in France: results of a prospective nationwide survey. For the group of epidemiology of the French association for the study of the liver (AFEF). Hepatology 32:477–481

    Article  CAS  PubMed  Google Scholar 

  30. Froehlich F, Lamy O, Fried M, Gonvers JJ (1993) Practice and complications of liver biopsy. Results of a nationwide survey in Switzerland. Dig Dis Sci 38:1480–1484

    Article  CAS  PubMed  Google Scholar 

  31. Sparchez Z (2005) Complications after percutaneous liver biopsy in diffuse hepatopathies. Rom J Gastroenterol 14:379–384

    PubMed  Google Scholar 

  32. Piccinino F, Sagnelli E, Pasquale G, Giusti G (1986) Complications following percutaneous liver biopsy. A multicentre retrospective study on 68,276 biopsies. J Hepatol 2:165–173

    Article  CAS  PubMed  Google Scholar 

  33. Kuroda T, Tanabe N, Sakatsume M, et al. (2002) Comparison of gastroduodenal, renal and abdominal fat biopsies for diagnosing amyloidosis in rheumatoid arthritis. Clin Rheumatol 21:123–128

    Article  CAS  PubMed  Google Scholar 

  34. Park MA, Mueller PS, Kyle RA, et al. (2003) Primary (AL) hepatic amyloidosis: clinical features and natural history in 98 patients. Medicine (Baltimore) 82:291–298

    Article  Google Scholar 

  35. Gertz MA, Comenzo R, Falk RH, et al. (2005) Definition of organ involvement and treatment response in immunoglobulin light chain amyloidosis (AL): a consensus opinion from the 10th international symposium on amyloid and amyloidosis. Am J Hematol 79:319–328

    Article  PubMed  Google Scholar 

  36. Kyle RA, Gertz MA, Greipp PR, et al. (1999) Long-term survival (10 years or more) in 30 patients with primary amyloidosis. Blood 93:1062–1066

    CAS  PubMed  Google Scholar 

  37. Ebert EC, Nagar M (2008) Gastrointestinal manifestations of amyloidosis. Am J Gastroenterol 103:776–787

    Article  PubMed  Google Scholar 

  38. Yood RA, Skinner M, Rubinow A, Talarico L, Cohen AS (1983) Bleeding manifestations in 100 patients with amyloidosis. JAMA 249:1322–1324

    Article  CAS  PubMed  Google Scholar 

  39. Kos CA, Ward JE, Malek K, et al. (2007) Association of acquired von Willebrand syndrome with AL amyloidosis. Am J Hematol 82:363–367

    Article  CAS  PubMed  Google Scholar 

  40. Barr RG (2014) Elastography in clinical practice. Radiol Clin North Am 52:1145–1162

    Article  PubMed  Google Scholar 

  41. Ferraioli G, Parekh P, Levitov AB, Filice C (2014) Shear wave elastography for evaluation of liver fibrosis. J Ultrasound Med 33:197–203

    Article  PubMed  Google Scholar 

  42. Millonig G, Reimann FM, Friedrich S, et al. (2008) Extrahepatic cholestasis increases liver stiffness (fibroScan) irrespective of fibrosis. Hepatology 48:1718–1723

    Article  PubMed  Google Scholar 

  43. Coco B, Oliveri F, Maina AM, et al. (2007) Transient elastography: a new surrogate marker of liver fibrosis influenced by major changes of transaminases. J Viral Hepat 14:360–369

    Article  CAS  PubMed  Google Scholar 

  44. Arena U, Vizzutti F, Corti G, et al. (2008) Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology 47:380–384

    Article  CAS  PubMed  Google Scholar 

  45. Romanque P, Stickel F, Dufour JF (2008) Disproportionally high results of transient elastography in patients with autoimmune hepatitis. Liver Int 28:1177–1178

    Article  PubMed  Google Scholar 

  46. Janssens F, Spahr L, Rubbia-Brandt L, Giostra E, Bihl F (2010) Hepatic amyloidosis increases liver stiffness measured by transient elastography. Acta Gastroenterol Belg 73:52–54

    CAS  PubMed  Google Scholar 

  47. Lanzi A, Gianstefani A, Mirarchi MG, et al. (2010) Liver AL amyloidosis as a possible cause of high liver stiffness values. Eur J Gastroenterol Hepatol 22:895–897

    Article  PubMed  Google Scholar 

  48. Srinivasan S, Tan YQ, Teh HS, Lee PJ, Khoo RN (2014) Primary hepatic amyloidosis presenting as nodular masses on the background of diffuse infiltration and extreme liver stiffness on MR elastography. J Gastrointest Liver Dis 23:437–440

    Google Scholar 

  49. Kim KM, Choi WB, Park SH, et al. (2007) Diagnosis of hepatic steatosis and fibrosis by transient elastography in asymptomatic healthy individuals: a prospective study of living related potential liver donors. J Gastroenterol 42:382–388

    Article  PubMed  Google Scholar 

  50. Foucher J, Chanteloup E, Vergniol J, et al. (2006) Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study. Gut 55:403–408

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Nguyen-Khac E, Chatelain D, Tramier B, et al. (2008) Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests. Aliment Pharmacol Ther 28:1188–1198

    Article  CAS  PubMed  Google Scholar 

  52. Yoshioka K (2013) How to adjust the inflammation-induced overestimation of liver fibrosis using transient elastography? Hepatol Rev 43(2):182–184

    Article  Google Scholar 

  53. Yoon KT, Lim SM, Park JY, et al. (2012) Liver stiffness measurement using acoustic radiation force impulse (ARFI) elastography and effect of necroinflammation. Dig Dis Sci 57(6):1682–1691

    Article  PubMed  Google Scholar 

  54. Pfeifer L, Strobel D, Neurath MF, Wildner D (2014) Liver stiffness assessed by acoustic radiation force impulse (ARFI) technology is considerably increased in patients with cholestasis. Ultraschall Med 35(4):364–367

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Abdominal Imaging and Intervention, Massachusetts General Hospital [MGH], Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Dmitry S. Trifanov, Manish Dhyani & Anthony E. Samir

  2. Department of Pathology, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA

    Jacob R. Bledsoe, Joseph Misdraji & Atul K. Bhan

  3. Department of Hepatology, Medicine, Massachusetts General Hospital [MGH], Harvard Medical School, Boston, MA, 02114, USA

    Raymond T. Chung

Authors
  1. Dmitry S. Trifanov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manish Dhyani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacob R. Bledsoe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph Misdraji
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atul K. Bhan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raymond T. Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anthony E. Samir
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manish Dhyani.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Trifanov, D.S., Dhyani, M., Bledsoe, J.R. et al. Amyloidosis of the liver on shear wave elastography: case report and review of literature. Abdom Imaging 40, 3078–3083 (2015). https://doi.org/10.1007/s00261-015-0519-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-015-0519-4

Keywords

Search

Navigation