Minamimoto Ryogo, Kubota Kazuo, Ishii Kenji, Morooka Miyako, Okasaki Momoko, Miyata Yoko, Nakajima Kazuhiko, Sato Takashi, Igari Toru, Hirai Risen, Okazaki Osamu
Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine Tokyo, Japan.
Am J Nucl Med Mol Imaging. 2013 Apr 9;3(3):261-71. Print 2013.
The definitive diagnosis of amyloidosis is made histologically with Congo red stain. Noninvasive imaging techniques for amyloidosis are beneficial for early and definite diagnosis of amyloid deposition in the body. (99m)Tc-aprotinin has the benefit of detecting amyloid deposits mainly in the heart, but it can also detect a wide range of lesions in other locations. The usefulness and limitations of (99m)Tc-Aprotinin scintigraphy for amyloid imaging were re-evaluated based on results from 25 patients (15 men and 10 women; median age, 62.9 y; range, 34-83 y). In addition, other nuclear tracers for imaging amyloidosis are discussed. Of the 25 patients with suspected amyloidosis, 19 patients were proven to have amyloid deposits by histopathological diagnosis. Major (99m)Tc-aprotinin positive sites were confirmed in the myocardium, thyroid, large joints, vertebrae, colon, and lungs. If (99m)Tc-Aprotinin images showed positive findings, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of existing amyloid deposits were 94.7, 33.3, 81.8, and 66.7%, respectively. For analysis based on biopsy region, the sensitivity, specificity, PPV, and NPV of existing amyloid deposition were 30.6, 82.6, 73.3, and 43.2%, respectively. (99m)Tc-Aprotinin has a high potential for diagnosis of amyloid deposition in body; however, due to its physiological uptake, its potential is limited for detection of amyloid deposits in the liver, kidney, and spleen.
淀粉样变性的确诊需通过刚果红染色进行组织学诊断。淀粉样变性的非侵入性成像技术有助于早期明确诊断体内的淀粉样蛋白沉积。（99m）Tc - 抑肽酶有助于检测主要在心脏的淀粉样蛋白沉积，但也能检测其他部位的多种病变。基于25例患者（15例男性和10例女性；中位年龄62.9岁；范围34 - 83岁）的结果，对（99m）Tc - 抑肽酶闪烁扫描术用于淀粉样成像的有效性和局限性进行了重新评估。此外，还讨论了用于淀粉样变性成像的其他核素示踪剂。在25例疑似淀粉样变性的患者中，19例经组织病理学诊断证实有淀粉样蛋白沉积。（99m）Tc - 抑肽酶主要在心肌、甲状腺、大关节、椎骨、结肠和肺部呈阳性。如果（99m）Tc - 抑肽酶图像显示阳性结果，现有淀粉样蛋白沉积的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为94.7%、33.3%、81.8%和66.7%。基于活检部位分析，现有淀粉样蛋白沉积的敏感性、特异性、PPV和NPV分别为30.6%、82.6%、73.3%和43.2%。（99m）Tc - 抑肽酶在诊断体内淀粉样蛋白沉积方面具有很大潜力；然而，由于其生理摄取，其在检测肝脏、肾脏和脾脏中淀粉样蛋白沉积的潜力有限。
