P-023: Assessment of liver stiffness with shear wave elastography for hepatic AL amyloidosis

Background Although liver is often involved in systemic AL amyloidosis, there are few modalities to differentiate amyloidosis from common hepatic disorders with hepatomegaly and serum ALP elevation. Because liver biopsy is an invasive procedure that may cause complications such as bleeding, a non-invasive imaging modality is wanted to diagnose and assess hepatic AL amyloidosis. Ultrasound shear wave elastography (SWE) is a novel imaging modality to evaluate tissue elasticity, which is currently applied to the quantitative assessment of liver stiffness in patients with diffuse liver disease. Herein, we investigated the efficacy of ultrasound SWE for diagnosis of hepatic involvement and assessment of hepatic organ response in patients with AL amyloidosis. Methods Thirteen patients with systemic AL amyloidosis (6 males and 7 females) with a median age of 65 years old (51-84) were studied. Hepatic involvement of AL amyloidosis was observed in 5 out of 13 patients without liver complications to affect liver stiffness. The ultrasound SWE was carried out for the right lobe of the liver, using an M-probe placed on the intercostal space. The long diagonal liver span was 18.24 ± 2.76 vs 13.11 ± 1.15 cm (p=0.003); serum ALP (normal range: 106 - 322 U/L) was 820.0 ± 537.62 vs 233.25 ± 30.52 U/L (p=0.013); and the shear wave velocity in a region of interest in SWE images was 2.02 ± 0.22 vs 1.33 ± 0.10 m/sec (p=0.001) in patients with and without hepatic involvement of AL amyloidosis, respectively. Results The shear wave velocity corresponded well to the severity of hepatic amyloid involvement judged by the liver size and serum ALP levels. The shear wave velocity was decreased after attaining hepatic organ response in 2 patients, while unchanged in those without hepatic response. Conclusions These results suggest that non-invasive ultrasound SWE is instrumental in diagnosis of hepatic involvement and assessment of hepatic organ response in AL amyloidosis, and provides unique information on amyloid deposition in the liver.