Imaging

Amyloidosis

Preliminary Diagnosis: Amyloidosis

I. What imaging technique is first-line for this diagnosis?

Amyloidosis is a histological diagnosis. However, some imaging modalities may suggest amyloidosis in the correct clinical setting. A first-line imaging modality is CT imaging of the area of interest with IV and oral contrast.

II. Describe the advantages and disadvantages of this technique for diagnosis of Amyloidosis.

Advantages

  • Highly sensitive and specific in detecting the surrounding soft tissues, osseous structures, and vasculature

  • May suggest a focal suspicious abnormality

  • May guide percutaneous biopsy and treatment

Disadvantages

  • Exposes patients to ionizing radiation

  • Amyloidosis is a histological diagnosis

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

IV. What alternative imaging techniques are available?

  • Contrasted MR imaging

  • Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Amyloidosis.

Contrasted MR imaging

Advantages

  • Does not expose patients to ionizing radiation

  • Offers exquisite visualization of the soft tissues

Disadvantages

  • Less adept in guiding percutaneous biopsy

  • Limited in evaluating the surrounding osseous structures

  • May be subject to motion and susceptibility weighted artifact degrading image quality

  • Expensive

  • Time-consuming

Ultrasound

Advantages

  • Highly portable

  • Does not expose patients to ionizing radiation

  • May help guide percutaneous biopsy and other intervention

Disadvantages

  • Offers limited evaluation of the surrounding soft tissues, osseous structures, and vasculature compared to companion CT and MR imaging

  • Amyloidosis is a histological diagnosis

VI. What are the contraindications for the alternative imaging techniques?

Contrasted MR imaging

  • May be contraindicated in patients with non-MR compatible hardware

Ultrasound

  • No specific contraindications to ultrasound exist

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