Thread by @MollyCarnahan

Amyloidosis: Multisystem spectrum of Disease with Pathologic Correlation
doi.org/10.1148/rg.202…

Check out this new @RadioGraphics article by @markdsugi et al. reviewing the full spectrum of amyloidosis.
#RGphx #Tweetorial #RadRes

@markdsugi
@MSalomaoMD
@sanjeevbhalla

AL: most common form of systemic amyloidosis in the US & seen with plasma cell dyscrasia.

AA: chronic infection/inflammation, solid organ malignancy & familial conditions.

ATTR: significant cause of morbidity and mortality related to cardiomyopathy.
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CNS β-amyloid deposits ➡️cerebral amyloid angiopathy (CAA) & Alzheimer disease (AD).

CAA is an important cause of multiple intracerebral hemorrhages or cerebral microbleeds, or alternatively, a single hemorrhage in the presence of cortical superficial siderosis.
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To evaluate AD, 2 PET tracers have complementary roles:
18F-florbetapir: binds β-amyloid fibrils & abnormal ⬆️ cortical gray matter uptake = amyloid deposits

18F-FDG (glucose analog): ⬇️uptake in post cingulate cortex, precuneus & parietotemporal cortices seen in AD
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MRI findings in cardiac amyloidosis include ⬆️ native T1 myocardial signal (nulling before blood pool) & diffuse subendocardial or transmural LGE
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Tracheobronchial amyloidosis ➡️ focal or segmental circumferential airway thickening including the posterior membrane +/- irregular calcs
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2 types of parenchymal pulmonary amyloidosis:
1) Nodular= solitary mass (amyloidoma) or multiple nodules, both can progressively calcify.
2) Diffuse alveolar septal type: basilar & subpleural consolidation w/ septal thickening & micronodules

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Renal amyloidosis most often occurs in systemic AL amyloidosis in the US. CT findings include parenchymal thinning and raely amorphous calcifications, which mimics medullary nephrocalcinosis. Ultrasound findings are nonspecific with echogenic parenchyma.
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Urinary tract amyloidosis is usually localized, most commonly involving the urinary bladder. CT findings include focal areas of wall thickening, irregular luminal narrowing & linear submucosal or intramural calcs.
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Liver is commonly involved in systemic amyloidosis. CT findings include hepatomegaly, masses, calcs, diffuse hypoattenuation (mimics steatosis), heterogeneity & post contrast mottled appearance. ⬆️ liver stiffness on MR elastography. #RGphx

AA amyloidosis on CT shows long-segment circumferential mural thickening & stratification (target sign) of the small bowel or areas of focal ulceration. AL amyloidosis has deposits in the submucosa and muscularis propria & CT shows nodular polypoid masses.
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Peritoneal amyloid deposition on CT appears as soft tissue infiltration of omental or mesenteric fat & have progressive dystrophic calcification over time.
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Breast involvement is rare but may occur in AL amyloidosis & can be localized or systemic forms of disease. Localized forms can present as palpable mass w/ imaging features that are difficult to distinguish from malignancy. Thus, tissue biopsy necessary.

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Carpal tunnel syndrome is the most common initial presentation of age-related, systemic wild-type ATTR. MRI features include thickening of the flexor tendons, osseous erosions & median nerve flattening
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Thanks for following along and don’t forget to check out the complete article @RadioGraphics here: doi.org/10.1148/rg.202…

And keep an eye out for more #RGphx #tweetorial
#Radres #RadEd #FOAMrad