Dialysis-related Amyloidosis Cervical Vertebral Body Destruction and Cord Compression.

Abstract

HomeRadiologyVol. 302, No. 1 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyDialysis-related Amyloidosis Cervical Vertebral Body Destruction and Cord CompressionChao-Hung Kuo, Tsung-Hsi Tu Chao-Hung Kuo, Tsung-Hsi Tu Author AffiliationsFrom the Department of Neurosurgery, Neurologic Institute, Taipei Veterans General Hospital, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan (C.H.K., T.H.T.); School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.H.K., T.H.T.); and Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.H.K.).Address correspondence to T.H.T. (e-mail: [email protected]).Chao-Hung KuoTsung-Hsi Tu Published Online:Oct 26 2021https://doi.org/10.1148/radiol.2021211521MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail A 64-year-old woman undergoing hemodialysis presented with progressive neck pain, bilateral hand clumsiness, and an unsteady gait. Cervical CT showed osteolytic lesions involving the odontoid process and body of the C2 vertebra (Figure, A), which was surrounded by a soft-tissue component that caused compression of the spinal cord and spinous processes in the C5 and C6 vertebrae (Figure, A). Cervical spine MRI (Figure, B) showed T2-weighted hypointense lesions at the C1 and C2 vertebrae and at the tips of the spinous processes of the C5 and C6 vertebrae, causing bony destruction and marked spinal stenosis at the C3–C6 vertebrae. Surgical intervention, including decompression and fixation, with biopsy was performed. The diagnosis of amyloid deposition was made at histopathologic examination (Figure, C).(A) Cervical CT scan shows osteolytic lesions (*) involving odontoid process and body of C2 vertebra surrounded by soft-tissue component with intraspinal epidural extension of soft-tissue component at C1 and C2 vertebrae and at C5 and C6 vertebrae, causing compression of spinal cord. Osteolytic lesion was also shown at tips of C5 and C6 spinous process. (B) T2-weighted cervical spine MRI scan shows hypointense lesions characteristic of amyloidosis at C1 and C2 vertebrae and at tips of C5 and C6 spinous processes, causing bone destruction and marked spinal stenosis at C3–C6 vertebrae. (C) Photomicrograph of biopsy specimen, viewed with polarized light and positively stained with Congo red, shows characteristic apple-green birefringence (arrowhead) (original magnification, ×100).Download as PowerPointOpen in Image Viewer Dialysis-related amyloidosis is one of the complications in patients undergoing long-term hemodialysis (1). Amyloid deposition predominantly involves the osteoarticular system of the shoulders, hips, and knees and causes erosive and destructive osteoarthropathies (1,2). Destructive spondyloarthropathy as a result of amyloid deposition may cause myeloradiculopathy because of cord or nerve root compression, for which surgical decompression and fixation would be indicated (1,2). Amyloid lesions are typically of low signal intensity at T2-weighted MRI examinations.Disclosures of Conflicts of Interest: C.H.K. No relevant relationships. T.H.T. No relevant relationships.