Contrast-enhanced ultrasound for differential diagnosis of suspected GvHD in patients after allogeneic transplantation.
GvHD is a serious complication in patients after allo-SCT, presenting with unspecific symptoms such as abdominal pain or cramps and diarrhea. Early diagnosis of GvHD, after differentiation from other causes leading to the same symptoms, such as viral or bacterial enteritis, is highly important because the time needed for diagnosing GvHD is directly correlated to a worsening of the outcome. We examined 23 patients presenting with the abdominal symptoms mentioned above, of whom 20 had received an allo-SCT in their history and were thus potential candidates for enteric GvHD. The other three patients were included because they also presented with abdominal symptoms similar to those of GvHD, which could be ruled out due to their history. We wanted to evaluate CEUS in these patients as an additional subgroup to gain more data on the value of CEUS in early detection of enteral GvHD and in the differentiation of GvHD against other causes of abdominal discomfort. All patients underwent CEUS with particular attention to penetration of the intravenously applied microbubbles in the bowel lumen. In the patients having allo-SCT in their history we strove to achieve histological confirmation of GvHD of the GI-tract. The resulting examinations were documented digitally. Out of 17 patients with confirmed GvHD of the GI tract, 14 showed penetration of the intravenously applied microbubbles into the bowel lumen, leading to a sensitivity and specificity of 82% and 100% for transmural bubble penetration for GvHD of the GI-Tract, since the patients without GvHD of the GI tract showed no transmural bubble penetration. In patients with viral or bacterial infections of the GI tract, no transmural penetration of the microbubbles into the bowel lumen was observed. For microbubble penetration as a criterion for GvHD of the GI-Tract, this leads to a negative predictive value (NPV) of 67%, and a positive predicative value (PPV) of 100%.
Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany. andreas.schreyer@klinik.uni-regensburg.de
Andreas G
AG
Schreyer
K
K
Landfried
E M
EM
Jung
N Platz Batista
NP
da Silva
F
F
Poschenrieder
C
C
Dornia
P
P
Wiggermann
L M
LM
Dendl
E
E
Holler
C
C
Stroszczynski
C
C
Friedrich
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000493:pharmacokinetics; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D042241:Early Diagnosis; D004751:Enteritis / Q000175:diagnosis; D005260:Female; D005767:Gastrointestinal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D006086:Graft vs Host Disease / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D010539:Permeability; D010743:Phospholipids / Q000493:pharmacokinetics; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013459:Sulfur Hexafluoride / Q000493:pharmacokinetics; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014463:Ultrasonography; D055815:Young Adult
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride