SCINTIGRAPHIC FUNCTIONAL HYPOSPLENISM IN AMYLOIDOSIS

Functional asplenia or hyposplenism may predispose patients to spontan eous splenic rupture and potentially increase the risk of serious infe ction, In addition, hyposplenism may be a marker of more extensive sys temic amyloidosis and has been correlated to a reduction in survival, Decreased splenic function is generally diagnosed by the presence of a bnormal red blood cell morphology and decreased splenic uptake on Tc-9 9m-sulfur colloid or microlite scans, We compared liver spleen scans w ith red cell morphology and anatomic imaging results in all patients w ith biopsy-proven amyloidosis who presented to the nuclear medicine de partment over a 12-yr period, Patients were referred from a center for amyloid disease for work-up of suspected hepatic involvement. Methods : Between 1983 and 1995, 23 liver spleen scans from 21 patients(one pa tient had three scans) with known amyloidosis were referred for the as sessment of degree of hepatic involvement with amyloid, All scans were retrospectively reviewed, and the degree of splenic uptake was graded . Medical records were reviewed for evidence of splenomegaly on physic al exam, Extent of splenic involvement also was assessed by anatomical imaging (CT or MRI) in 45% of cases, Peripheral smear reports were re viewed for the presence of abnormal red cell morphology consistent wit h hyposplenism. Results: Splenic activity was moderately or markedly r educed in 22 of 23 liver spleen scans (21 patients), Eight of these sc ans had correlative anatomic splenic imaging: four were abnormal and f our were normal, Forty-one percent of available peripheral smears cont ained abnormal red cell morphology. Nine patients had palpable splenom egaly at the time of the liver spleen scan, Splenic pathologic studies were available for three patients (two autopsy, one surgical) and dem onstrated diffuse splenic infiltration with amyloidosis, One patient h ad spontaneous splenic rupture. Fourteen patients died, four of overwh elming infection, Conclusion: Reduced splenic uptake on liver spleen s cans for patients with suspected hepatic infiltration with amyloid is a common finding. Liver spleen scanning appears to be a more sensitive marker of splenic amyloidosis than clinical parameters or anatomical imaging.