Amyloidosis of the liver on shear wave elastography: case report and review of literature

Abstract

Amyloidosis is extremely rare, with an estimated 2225 new US cases reported annually. Signs and symptoms of the disease are subtle and imaging findings are not pathognomonic. Currently, diagnosis requires biopsy to demonstrate the deposition of amyloid. Elastography is a new imaging modality that evaluates tissue elasticity. It has shown to have efficacy in characterizing thyroid nodules, detecting prostate cancer, and staging liver fibrosis. We present a case of hepatic amyloidosis in a 51-year-old male that demonstrates significantly increased stiffness with a median value of 99.1 kPa (range 25.7-188.9 kPa) on shear-wave elastography (SWE) imaging, which is significantly higher than the cut-off range reported for cirrhosis on SWE (10.4-11.5 kPa). This finding raises the possibility that elastographic imaging may be sensitive to tissue mechanical changes induced by amyloid deposition.

Portal Hypertension and a Stiff Liver

“…Interestingly, 2D-SWE (a modern ultrasound elastography technique which provides B-mode imaging in addition to elasticity measurements, and which can be performed in patients with ascites) [ 1 ] demonstrated extremely high values (mean 99.4 kPa), which are compatible with, but not typical of cirrhosis (usually not exceeding 70-75 kPa). Two previous cases have reported extremely high values of liver stiffness measured either with TE or with SWE [ 17 - 18 ], similar to the ones observed in our patient.…”

Validation of Shear Wave Elastography Cutoff Values on the Supersonic Aixplorer for Practical Clinical Use in Liver Fibrosis Staging

“…Subjects with rare diseases were also excluded from the study as there is literature suggesting these diseases confound SWE measurement (Trifanov et al 2015). Finally, patients whose SWE image review was not satisfactory as defined above were also excluded.…”

Hepatic Amyloidosis with an Extremely High Stiffness Value on Magnetic Resonance Elastography

“…Recently, several articles have reported very high liver stiffness values in hepatic amyloidosis, as in our case, using ultrasound-based and MR-based elastography. 4 Hepatic amyloidosis should be considered for cases of liver dysfunction with unexpectedly high liver stiffness values.…”