Usefulness of magnetic resonance imaging of the wrist for the early diagnosis of dialysis-related amyloidosis

Dialysis-related amyloidosis (DRA) is a major complication of long-term hemodialysis patients. The onset of arthropathy is frequently preceded by carpal tunnel syndrome, but the early non-invasive diagnosis of DRA remains unclear. beta 2-microglobulin amyloid deposits in joint synovia and soft tissue precede radiological abnormalities. Magnetic resonance imaging (MRI) may play a more important role in the early diagnosis of DRA, because it allows direct visualization of synovitis and deposition of abnormal soft tissue. The purpose of this study was to evaluate the usefulness of MRI of the wrist for the early diagnosis of DRA. The study included 72 patients (male 37, female 35) undergoing hemodialysis from initiation to 20 years. The patients were examined by MR images of synovitis, deposition of abnormal soft tissue and cystic bone lesions at the wrists. Normal MR images of synovia and soft tissue were defined in 6 control subjects (2 normal 4 non-dialysis patients). Synovitis of the carpal bones was found in 23% of the patients at the start of hemodialysis. Deposition of abnormal soft tissue in the carpal canal and cystic bone lesions were detected after 1 and 2 years of hemodialysis, respectively. All findings were increased significantly with an increasing duration of dialysis. Synovitis was present in 90% of the patients with deposition of abnormal soft tissue, and in 80% of the patients with cystic bone lesions. beta 2-microglobulin value was significantly higher in patients with synovitis, deposition of abnormal soft tissue and cystic bone lesions than in patients without these findings. Our experience suggest that synovitis examined by MRI of the wrists is useful for the early diagnosis of DRA. Thereby, intensive follow-up and management of DRA are required in patients with synovitis at the start of hemodialysis.