UTILITY OF HIGH-RESOLUTION ULTRASOUND FOR THE DIAGNOSIS OF DIALYSIS-RELATED AMYLOIDOSIS

Objective. To evaluate the utility of real-time, high-resolution ultrasound of the shoulder in the diagnosis of dialysis-related amyloidosis. Methods. We performed a case series study of 2 groups of patients seen at a referral-based clinic in a tertiary care hospital. The shoulders of 13 patients with normal renal function and of 38 patients receiving long-term hemodialysis were studied by real-time, high-resolution ultrasound. All hemodialysis patients were evaluated clinically for the presence of dialysis-related amyloidosis. Surgical specimens of joints were available for all 13 patients with normal renal function and for 17 of the 38 hemodialysis patients. These specimens were evaluated for the presence of beta-2-microglobulin (beta-2m) amyloid by Congo red and immunohistochemical staining. Results. Two ultrasonographic findings were selectively observed in the dialysis patients with clinical and histologic evidence of beta-2m amyloid in comparison with patients with normal renal function and no evidence of amyloid: rotator cuffs >8 mm in thickness and echogenic pads between muscle groups of the rotator cuff. The presence of at least 1 of these 2 findings corresponded to the presence of clinically and histologically evident beta-2m amyloid with a sensitivity of 79 % and a specificity of 100 %. When additional patients without surgical specimens for histologic confirmation of amyloidosis were included, the sensitivity of these 2 sonographic findings was 72 % and the specificity was 97 %. Conclusion. Real-time, high-resolution ultrasound is a relatively sensitive and highly specific non-invasive adjunct to the clinical diagnosis of beta-2m amyloidosis in patients receiving long-term hemodialysis.