Scintigraphic functional hyposplenism in amyloidosis

Area of Science:

• Nuclear Medicine
• Hematology
• Radiology

Background:

• Functional asplenia/hyposplenism increases risk of infection and splenic rupture.
• Hyposplenism can be a marker for systemic amyloidosis and reduced survival.
• Diagnosis of decreased splenic function involves abnormal red blood cell morphology and reduced uptake on scans.

Purpose of the Study:

• To compare liver spleen scans with red cell morphology and anatomical imaging.
• To assess splenic function in patients with biopsy-proven amyloidosis.
• To evaluate liver spleen scanning as a marker for splenic amyloidosis.

Main Methods:

• Retrospective review of 23 liver spleen scans from 21 patients with amyloidosis (1983-1995).
• Grading of splenic uptake, review of medical records for splenomegaly, and assessment of anatomical imaging (CT/MRI).
• Analysis of peripheral smear reports for abnormal red cell morphology consistent with hyposplenism.

Main Results:

• Reduced splenic activity observed in 22 of 23 liver spleen scans.
• Abnormal red cell morphology found in 41% of peripheral smears.
• Splenic amyloidosis was confirmed pathologically in three patients; one experienced spontaneous splenic rupture.

Conclusions:

• Reduced splenic uptake on liver spleen scans is common in patients with suspected hepatic amyloid infiltration.
• Liver spleen scanning is a more sensitive marker for splenic amyloidosis than clinical parameters or anatomical imaging.