99mTc-Aprotinin Scintigraphy in Amyloidosis

^99mTc-Aprotinin Scintigraphy in Amyloidosis

Bente K. Schaadt, MD, PhD¹^,2, Helle W. Hendel, MD, PhD¹, Peter Gimsing, MD, MSc³, Viggo Jønsson, MD, DMSc³, Heidi Pedersen, Bpharm⁴ and Birger Hesse, MD, DMSc¹

¹ Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
² Department of Clinical Physiology and Nuclear Medicine, Hillerød Sygehus, Hillerød, Denmark
³ Department of Haematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
⁴ Section for Radiopharmacy, Danish Medicines Agency, Copenhagen, Denmark

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FIGURE 1. An 86-y-old woman (patient 1) with IgG ${kappa}$ multiple myeloma developed carpal tunnel syndrome, progressive submandibular masses, and swelling of tongue. At time of scintigraphy, patient did not have abdominal symptoms but later developed severe constipation due to intestinal amyloidosis. ^99mTc-Aprotinin scintigrams show pathologic uptake in heart and parts of intestine (A, abdominal anterior projection), both hands (B, dorsal view), and tongue and submandibular glands (C, left lateral projection of head).

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FIGURE 2. A 50-y-old man (patient 14) suffering from severe polyneuropathy during last year, slight functional dyspnea, and coughing. Biopsy of sural nerve showed unspecific axonal atrophy. His mother had died from polyneuropathy and amyloid cardiomyopathy. Scintigram shows pleural and cardiac accumulations of aprotinin (A, anterior view). (B) SPECT tomograms of chest show pronounced aprotinin uptake in interventricular septum and less pronounced uptake in lateral wall and apex of heart. VLA = vertical long axis; HLA = horizontal long axis; SA = short axis.

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FIGURE 3. A 64-y-old man (patient 5) with renal AL amyloidosis. Whole-body scintigram shows pathologic uptake in heart, liver, and right lung or pleura (anterior view). Patient had no symptoms from heart at time of scintigraphy but died of heart failure 8 mo later.

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FIGURE 4. Whole-body scintigram shows pathologic uptake in left maxillary sinus in 78-y-old woman (patient 6) with plasmacytoma. Several accumulations in calvarium, lungs or pleura, left femur, and shoulder are also revealed. Patient had no symptoms from these sites, but physical examination of calvarium revealed palpable masses and biopsy confirmed amyloid. (A) Anterior view. (B) Posterior view.

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FIGURE 5. A 62-y-old man (patient 3) with plasmacytoma in upper mediastinum with destruction of sternum and extrathoracic component. CT scan also showed tumor in region of left os zygomaticus. ^99mTc-Aprotinin scintigram reveals pathologic uptake in upper mediastinum, left eye region, left shoulder, and liver (anterior view).