Novel imaging techniques using 18F‐florbetapir PET/MRI can guide fascicular nerve biopsy in amyloid multiple mononeuropathy. Issue 1 (4th November 2020)

• Record Type: Journal Article
• Authors: Shouman, Kamal; Broski, Stephen M.; Muchtar, Eli; Pendleton, Courtney A.; Johnson, Geoffrey B.; Tracy, Jennifer; Engelstad, Janean K.; Spinner, Robert J.; Dyck, P. James B.
• Is Part Of: Muscle & nerve. Volume 63:Issue 1(2021)
• Page Start: 104
• Page End: 108
• Publication Date: 2020-11-04
• Subjects: 18F‐florbetapir PET/MRI -- amyloidosis -- MR neurography -- multiple mononeuropathy -- sural nerve biopsy; Neuromuscular diseases -- Periodicals; Muscles -- Periodicals; Nerves -- Periodicals; 616.74
• DOI: 10.1002/mus.27100
• Languages: English
• ISSNs: 0148-639X

Abstract

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.