Magnetic resonance imaging in sclerotic-type chronic graft-vs-host disease.
BACKGROUND
Sclerotic-type chronic graft-vs-host disease (cGVHD) of the skin is an uncommon but potentially debilitating sequela of allogeneic hematopoietic stem cell transplantation. There is no standardized assessment measure for this form of cGVHD. Because a full-thickness incisional biopsy specimen to the level of the fascia may be needed to make a definitive histologic diagnosis of cGVHD-related fasciitis, a noninvasive technique for the assessment and monitoring of sclerotic-type cGVHD, particularly cGVHD-related fasciitis, would be of potential value.


METHODS
Sixty-two consecutive patients with cGVHD following allogeneic hematopoietic stem cell transplantation were evaluated for sclerotic skin disease. Forty-four patients (71%) had cutaneous cGVHD, and 28 patients (45%) had evidence of sclerotic involvement based on physical examination findings. Fifteen patients agreed to undergo research magnetic resonance imaging to evaluate quantifiable changes in the dermis, subcutaneous tissue, and muscle. Among 15 patients, magnetic resonance imaging identified abnormalities in the skin in 7 (47%), subcutaneous fibrous septa in 13 (87%), deep fascia in 12 (80%), epimysium in 9 (60%), and muscle in 3 (20%).


CONCLUSIONS
Magnetic resonance imaging should be considered in the evaluation of patients with cGVHD suspected of having subcutaneous or fascial involvement. Additional studies are needed to validate this noninvasive modality for serial monitoring of disease activity and response to therapy. Trial Registration clinicaltrials.gov Identifier: NCT00331968.
Clark
Jason
J
Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
Yao
Lawrence
L
Pavletic
Steven Z
SZ
Krumlauf
Michael
M
Mitchell
Sandra
S
Turner
Maria L
ML
Cowen
Edward W
EW
D000328:Adult; D003287:Contrast Media; D005208:Fasciitis / Q000175:diagnosis / Q000209:etiology; D005260:Female; D019786:Gadolinium DTPA; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012598:Sclerosis; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
D003287:Contrast Media; D019786:Gadolinium DTPA
J Clin Oncol. 2007 Sep 20;25(27):4255-61
17878478
Biol Blood Marrow Transplant. 2005 Dec;11(12):945-56
16338616
Biol Blood Marrow Transplant. 2007 Jun;13(6):715-23
17531782
Biol Blood Marrow Transplant. 2006 Nov;12(11):1101-13
17085303
Arthritis Rheum. 2000 Aug;43(8):1866-73
10943878
AJR Am J Roentgenol. 2005 Jan;184(1):169-74
15615969
J Am Acad Dermatol. 2005 Oct;53(4):591-601
16198778
Clin Imaging. 2001 Mar-Apr;25(2):138-40
11483427
Dermatology. 2008;216(4):287-304
18230976
Biol Blood Marrow Transplant. 2006 Mar;12(3):252-66
16503494
Eur J Radiol. 1999 Apr;30(1):11-21
10389007