Article Figures & Data
Figures
- FIGURE 1.
An 86-y-old woman (patient 1) with IgGκ 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).
- 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.
- 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.
- 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.
- 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).
Tables
- TABLE 1
Characteristics of 23 Consecutive Patients with Known or Suspected Amyloidosis and Findings on 99mTc-Aprotinin Scintigraphy
Patient no. Sex Age (y) Type of amyloidosis/coexisting malignant disease and clinical conditions 99mTc-Aprotinin accumulations on scintigraphy Biopsy or autopsy positive or negative* Symptoms on scintigraphy† 1 F 86 AL amyloidosis/IgGκ multiple myeloma Hands + Tongue + + Submandibular glands + + Heart, intestines − 2 M 39 AL amyloidosis renis/nephrotic syndrome, multiple myeloma (κ light-chain disease) Heart + + Paraaortic lymph nodes + − Liver + − Spleen + − 3 M 62 AL amyloidosis/plasmacytoma with amyloidosis, multiple myeloma (λ light-chain disease) Left eye region +‡ Upper mediastinum + + Left shoulder + Liver − 4 M 59 AL amyloidosis/IgGκ M component, MGUS Heart, liver − Spleen − —— + rectum, + bone marrow, + lip 5 M 64 AL amyloidosis renis/(λ light chain in urine) Heart + − Right lung/pleura + − Liver + − Spleen + − 6 F 78 AL amyloidosis/initially plasmacytoma, multiple myeloma (κ light-chain disease) Both pleura/lungs − Left maxillary sinus + + Calvarium + + Right shoulder + − Left femur − 7 F 66 AL amyloidosis renis/multiple myeloma IgAλ Lungs − Liver, intestines − 8 F 70 Clinically evident amyloidosis/multiple myeloma (λ light-chain disease) Liver, spleen − 9 F 56 Localized amyloidosis in plica vocalis/no myeloma Liver − − — + plica vocalis + 10 F 66 Clinically evident amyloidosis/IgAλ multiple myeloma Heart +§ Tongue + Liver − 11 F 75 AL amyloidosis renis Liver + + Spleen − 12 F 45 Localized amyloidosis in biopsy of sural nerve — + of sural nerve Polyneuropathy 13 M 55 AL amyloidosis/IgGκ multiple myeloma Heart + +¶ 14 M 50 Hereditary amyloidosis Heart + + Pleura, intestines − 15 M 73 AL amyloidosis renis/IgMκ macroglobulinemia Waldenström Lungs − Liver, spleen − Intestines − 16 F 57 Hereditary amyloidosis Heart + Lungs + Liver, pleura − 17 F 60 Clinically evident amyloidosis/IgGκ multiple myeloma Lungs + Liver − 18 F 58 AL amyloidosis/macroglobulinemia Waldenström, and cold-agglutinin syndrome Liver + Spleen, intestines, lungs − All major joints + Metacarpophalangeal regions and fingers + pathologic fracture of right femur, + bone marrow + 19 F 58 Localized amyloidosis in bronchial biopsy Lungs, liver − 20 M 54 AL amyloidosis/IgMκ Liver + + Spleen + − Intestines + + heart,‖ + alveolar walls, + vascular walls in lungs, + bone marrow + 21 F 67 AL amyloidosis/nephrotic syndrome IgAλ Liver + Spleen, lungs − Shoulders, nasopharynx − 22 M 53 AL amyloidosis/multiple myeloma, gastrointestinal and bone marrow amyloid deposits Tongue + Pleura − Liver, spleen − 23 F 57 AL amyloidosis of lungs Lungs + + Liver − ↵* Positive (+) or negative in relation to scintigraphic findings.
↵† Positive (+) = symptoms on scintigraphy; negative (−) = no symptoms on scintigraphy.
↵‡ Had scintigraphy performed twice within 6 mo after chemotherapy and autologous transplantation of bone marrow and had clinical, paraclinical, and scintigraphic reduction of tumor size in mediastinum.
↵§ After medical treatment with alkaran and prednisolone, patient had regression of symptoms.
↵¶ Had scintigraphy performed twice within 6 mo after chemotherapy and autologous transplantation of bone marrow with remission of multiple myeloma, but no change in cardiac uptake on scintigraphy or cardiac performance.
↵‖ Cardiac region was not sufficiently covered by scintigraphic study.
MGUS = monoclonal gammopathy of unknown significance.
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