Early and late-onset acute GvHD following hematopoietic cell transplantation: CT features of gastrointestinal involvement with clinical and pathological correlation

• Published in: European journal of radiology Vol. 73; no. 3; pp. 594 - 600
• Main Authors: Brodoefel, H., Bethge, W., Vogel, M., Fenchel, M., Faul, C., Wehrmann, M., Claussen, C., Horger, M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.03.2010
• Subjects: Abdominal CT; Acute intestinal GvHD; Adult; Aged; Correlation with clinical and pathological grading; Female; Gastrointestinal Diseases - diagnostic imaging; Gastrointestinal Diseases - pathology; Graft vs Host Disease - diagnostic imaging; Graft vs Host Disease - pathology; Graft vs Host Disease - prevention & control; Hematopoietic Stem Cell Transplantation; Humans; Late-onset GvHD; Logistic Models; Male; Middle Aged; Radiographic Image Interpretation, Computer-Assisted; Radiography, Abdominal - methods; Radiology; Retrospective Studies; Statistics, Nonparametric; Tomography, X-Ray Computed - methods; Transplantation Conditioning; Acute intestinal GvHD; Correlation with clinical and pathological grading; Late-onset GvHD; Abdominal CT
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2009.01.011

With the introduction of non-myeloablative hematopoietic cell transplantation, acute graft-versus-host-disease (GvHD) is frequently observed beyond the traditional 100 days cut-off. The aim of this study was to describe and compare CT features of gastrointestinal early and late-onset GvHD and to correlate findings with clinical and pathology grading. Abdominal CT scans were obtained in 20 patients with early and 15 with late-onset GvHD. Examinations were assessed for intestinal and extraintestinal abnormalities and findings compared between the two subgroups of GvHD. Distinct CT abnormalities as well as a CT-score integrating multiple pathologies were correlated with gut, clinical or pathology grading. Frequent intestinal abnormalities included wall thickening, abnormal enhancement, and excessive fluid-filling (94%, 89%, and 94%). 86% of patients showed concomitant small and large bowel involvement. A discontinuous distribution was observed in 54%. Bile tract abnormality was the most common extra-intestinal finding (74%). The distribution of pathologies was equal between subgroups of early or late-onset disease. Wall thickening and mucosal attenuation in non-enhanced scans were significantly related to clinical and pathology scores ( P ≤ 0.018). Number of abnormal segments, small bowel dilatation, engorgement of the vasa recta, mesenteric fat stranding and ascites were linked to clinical grading ( P ≤ 0.019). A CT-score integrating multiple abnormalities was correlated to gut, overall clinical and pathology grading ( r = 0.64, 0.57, 0.50). CT morphology of acute GvHD is independent of its time of onset and, thus, facilitates differential diagnosis of late-onset acute GvHD. Correlation of CT morphology with clinical and pathological grading is important in terms of prognosis and may help guiding the therapeutic approach.