1. Novel imaging techniques using 18 F‐florbetapir PET/MRI can guide fascicular nerve biopsy in amyloid multiple mononeuropathy
- Author
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P. James B. Dyck, Eli Muchtar, Stephen M. Broski, Janean K. Engelstad, Courtney Pendleton, Robert J. Spinner, Geoffrey B. Johnson, Kamal Shouman, and Jennifer A. Tracy
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Nerve biopsy ,medicine.diagnostic_test ,Physiology ,business.industry ,Amyloidosis ,Magnetic resonance neurography ,Magnetic resonance imaging ,030105 genetics & heredity ,medicine.disease ,Mononeuropathy ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,Amyloid Neuropathy ,0302 clinical medicine ,Positron emission tomography ,Physiology (medical) ,AL amyloidosis ,Medicine ,Neurology (clinical) ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Background Multiple mononeuropathy is a rare presentation of primary (AL) amyloidosis and nerve biopsy is usually needed for diagnosis. Conventional imaging is useful to identify proximal nerve involvement but may be inadequate. We report a patient with multiple mononeuropathy whose presentation was suggestive of AL amyloid neuropathy and in whom repeated tissue biopsies were negative for amyloid (including two sensory nerves and one muscle). Methods The patient underwent magnetic resonance imaging (MRI) and whole body 18 F-florbetapir positron emission tomography (PET)/MRI. Results Whole body 18 F-florbetapir PET/MRI revealed abnormal low-level florbetapir uptake in the right proximal tibial and peroneal nerves, which provided a target for a sciatic bifurcation fascicular nerve biopsy that was diagnostic of AL amyloidosis. Conclusions 18 F-florbetapir PET/MRI imaging is a promising diagnostic tool for patients with suspected peripheral nerve amyloidosis (including multiple mononeuropathy) in whom conventional imaging and nerve and muscle biopsies miss the pathology.
- Published
- 2020