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


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Brodoefel
H
H
Department of Diagnostic Radiology, Eberhard-Karls-University, 72076 Tübingen, Germany. h.brodoefel@t-online.de
Bethge
W
W
Vogel
M
M
Fenchel
M
M
Faul
C
C
Wehrmann
M
M
Claussen
C
C
Horger
M
M
D000328:Adult; D000368:Aged; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011857:Radiographic Image Interpretation, Computer-Assisted; D011860:Radiography, Abdominal / Q000379:methods; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019172:Transplantation Conditioning