title: CT in the clinical and prognostic evaluation of acute graft-vs-host disease of the gastrointestinal tract.
abstract: OBJECTIVE
  To determine the role of abdominal CT in assessment of severity and prognosis of patients with acute gastrointestinal (GI) graft-vs-host disease (GVHD).
  
  
  METHODS
  During 2000-2004, 41 patients with a clinical diagnosis of acute GI-GVHD were evaluated. CTs were examined for intestinal and extra-intestinal abnormalities, and correlated with clinical staging and outcome.
  
  
  RESULTS
  20 patients had GVHD clinical Stage I-II and 21 had Stage III-IV. 39 (95%) had abnormal CT appearances. The most consistent finding was bowel wall thickening: small (n=14, 34%) or large (n=5, 12%) bowel, or both (n=20, 49%). Other manifestations included bowel dilatation (n=7, 17%), mucosal enhancement (n=6, 15%) and gastric wall thickening (n=9, 38%). Extra-intestinal findings included mesenteric stranding (n=25, 61%), ascites (n=17, 41%), biliary abnormalities (n=12, 29%) and urinary excretion of orally administered gastrografin (n=12, 44%). Diffuse small-bowel thickening and any involvement of the large bowel were associated with severe clinical presentation. Diffuse small-bowel disease correlated with poor prognosis. 8 of 21 patients responded to therapy, compared with 15 of 20 patients with other patterns (p=0.02), and the cumulative incidence of GVHD-related death was 62% and 24%, respectively (p=0.01). Overall survival was not significantly different between patients with diffuse small-bowel disease and patients with other patterns (p=0.31). Colonic disease correlated with severity of GVHD (p=0.04), but not with response to therapy or prognosis (p=0.45).
  
  
  CONCLUSIONS
  GVHD often presented with abdominal CT abnormalities. Diffuse small-bowel disease was associated with poor therapeutic response. CT may play a role in supporting clinical diagnosis of GI GVHD and determining prognosis.
authors: Division of Hematology and Bone Marrow Transplantation, Sheba Medical Center, Tel-Hashomer, affiliated to Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors: A
authors: A
authors: Shimoni
authors: U
authors: U
authors: Rimon
authors: M
authors: M
authors: Hertz
authors: R
authors: R
authors: Yerushalmi
authors: M
authors: M
authors: Amitai
authors: O
authors: O
authors: Portnoy
authors: L
authors: L
authors: Guranda
authors: A
authors: A
authors: Nagler
authors: S
authors: S
authors: Apter
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D003287:Contrast Media; D003967:Diarrhea / Q000209:etiology; D003974:Diatrizoate Meglumine; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D036542:Tomography, Spiral Computed / Q000379:methods; D014184:Transplantation, Homologous
chemical_list: D003287:Contrast Media; D007166:Immunosuppressive Agents; D003974:Diatrizoate Meglumine