Novel noninvasive parameters for diagnosis of liver involvement in patients with systemic AL amyloidosis

Liver involvement in systemic immunoglobulin light-chain (AL) amyloidosis is diagnosed by an increase in liver size and/or elevated serum alkaline phosphatase (ALP) levels. However, novel diagnostic approaches that reflect the organ-specific characteristics of liver involvement are needed. Shear wave elastography (SWE) is a noninvasive and repeatable technique for measuring tissue stiffness. In this study, we evaluated the clinical significance of SWE and serum biochemistry tests in the diagnosis of AL amyloidosis with liver involvement. Twenty-five patients with systemic AL amyloidosis were examined. Eight patients were diagnosed with liver involvement according to the current consensus criteria. In patients with and without liver involvement, hepatic shear wave velocity (SWV) was 1.93 ± 0.39 versus 1.36 ± 0.11 m/sec (p = 0.00099), and the gamma-glutamyltranspeptidase (γ-GTP) level was 165 ± 131 versus 36 ± 28 U/L (p = 0.00222). Receiver-operating characteristic curve analysis showed that SWV and γ-GTP levels had favorable diagnostic accuracy for liver involvement. Of note, two patients with liver involvement who achieved organ response showed a decrease in both SWV and γ-GTP levels. These results suggest that SWV and γ-GTP are useful for establishing accurate organ-specific diagnosis and response criteria for liver involvement in AL amyloidosis.