Imaging in systemic amyloidosis.
Imaging in systemic amyloidosis.
复制标题
系统性淀粉样变性的影像学。
DOI：
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发表时间：
2013
影响因子：
6.7
通讯作者：
A. Wechalekar
中科院分区：
文献类型：
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作者：
S. Sachchithanantham;A. Wechalekar
背景
系统性淀粉样变性的诊断仍然具有挑战性。组织学是目前诊断淀粉样变性的金标准，它对疾病的程度提供的信息有限，对监测没有帮助。非侵入性成像方式提供了一种简单的方法来评估全身淀粉样蛋白负荷，准确地识别器官受累，量化和监测疾病进展和对治疗的反应。
数据来源
使用PubMed对“淀粉样蛋白成像”、“SAP血管造影术”、“心脏淀粉样变性成像"、”心脏MRI“、”PET和淀粉样变性“和”淀粉样变性核成像“主题进行文献检索。
意见一致的领域
I-SAP造影是常规临床应用中评估所有类型淀粉样变性中内脏淀粉样蛋白沉积程度和分布的最佳和唯一方法。超声心动图仍然是评估心脏淀粉样变性最重要的工具，但心脏磁共振成像正变得越来越有价值。骨示踪剂如99 mTc-DPD和焦磷酸盐开始在甲状腺素运载蛋白心脏淀粉样变性成像中发挥作用。
限制
每种成像方式的特异性限制了任何一种成像方法对所有器官的所有类型淀粉样变性的效用。生长点和进一步研究：99 mTc-DPD对心脏甲状腺素运载蛋白淀粉样沉积具有高度的敏感性和特异性，其在早期诊断这种疾病中的作用正在研究中。需要进一步研究I-mIBG以评估其在早期心脏自主神经病变患者中的效用。用于阿尔茨海默病成像的示踪剂正电子发射断层扫描是系统性淀粉样蛋白成像中越来越感兴趣的领域。
BACKGROUND
Diagnosis of systemic amyloidosis remains challenging. Histology, the current gold standard for diagnosis of amyloidosis provides limited information on the extent of the disease and is not useful for monitoring. Non-invasive imaging modalities offer an easy way to evaluate whole-body amyloid burden, accurately identify organ involvement, quantify and monitor disease progression and response to treatment.
SOURCES OF DATA
A literature search was performed using PubMed on the subjects of 'amyloid imaging', 'SAP scintigraphy', 'imaging in cardiac amyloidosis', 'cardiac MRI', 'PET and amyloidosis' and 'nuclear imaging in amyloidosis'.
AREAS OF AGREEMENT
¹²³I-SAP scintigraphy is the best and the only modality in routine clinical use for assessing the extent and distribution of visceral amyloid deposition in all types of amyloidosis. Echocardiography remains the most important tool for assessing cardiac amyloidosis but cardiac magnetic resonance imaging is becoming increasingly valuable. Bone-seeking tracers like 99mTc-DPD and pyrophosphate are beginning to have a role in imaging transthyretin cardiac amyloidosis.
LIMITATIONS
Specificity of each of the imaging modalities limits the utility of any one imaging method for all types of amyloidosis for all organs. GROWING POINTS AND FURTHER RESEARCH: 99mTc-DPD has a high sensitivity and specificity to cardiac transthyretin amyloid deposits and its role in early diagnosis of this condition is under investigation. Further studies are needed with ¹²³I-mIBG to assess its utility in patients with early cardiac autonomic neuropathy. Positron emission tomography with tracers used for Alzheimer's disease imaging is an area of increasing interest in systemic amyloid imaging.