title: Imaging findings and therapy response monitoring in chronic sclerodermatous graft-versus-host disease: preliminary data of a simultaneous PET/MRI approach.
abstract: OBJECTIVE
  Our objective was a multifunctional imaging approach of chronic sclerodermatous graft-versus-host disease (ScGVHD) and its course during therapy using PET/MRI.
  
  
  METHODS
  We performed partial-body PET/CT and PET/MRI of the calf in 6 consecutively recruited patients presenting with severe ScGVHD. The patients were treated with different immunosuppressive regimens and supportive therapies. PET/CT scanning started 60.5 ± 3.3 minutes, PET/MRI imaging 139.5 ± 16.7 minutes after (18)F-FDG application. MRI acquisition included T1- (precontrast and postcontrast) and T2-weighted sequences. SUV(mean), T1 contrast enhancement, and T2 signal intensity from region-of-interest analysis were calculated for different fascial and muscular compartments. In addition, musculoskeletal MRI findings and the modified Rodnan skin score were assessed. All patients underwent imaging follow-up.
  
  
  RESULTS
  At baseline PET/MRI, ScGVHD-related musculoskeletal abnormalities consisted of increased signal and/or thickening of involved anatomical structures on T2-weighted and T1 postcontrast images as well as an increased FDG uptake. At follow-up, ScGVHD-related imaging findings decreased (SUV(mean) n = 4, mean T1 contrast enhancement n = 5, mean T2 signal intensity n = 3) or progressed (SUV(mean) n = 3, mean T1 contrast enhancement n = 2, mean T2 signal intensity n = 4). Clinically modified Rodnan skin score improved for 5 follow-ups and progressed for 2. SUV(mean) values correlated between PET/CT and PET/MRI acquisition (r = 0.660, P = 0.014), T1 contrast enhancement, and T2 signal (r = 0.668, P = 0.012), but not between the SUV(mean) values and the MRI parameters.
  
  
  CONCLUSIONS
  PET/MRI as a combined morphological and functional technique seems to assess the inflammatory processes from different points of view and provides therefore in part complementary information.
authors: Department of Radiology, Diagnostic and Interventional Radiology, University Hospital of Tübingen, Germany. alexander.sauter@klinikum.uni-tuebingen.de
authors: Alexander W
authors: AW
authors: Sauter
authors: Holger
authors: H
authors: Schmidt
authors: Frederic
authors: F
authors: Mantlik
authors: Armin
authors: A
authors: Kolb
authors: Birgit
authors: B
authors: Federmann
authors: Christina
authors: C
authors: Pfannenberg
authors: Matthias
authors: M
authors: Reimold
authors: Bernd J
authors: BJ
authors: Pichler
authors: Wolfgang
authors: W
authors: Bethge
authors: Marius S
authors: MS
authors: Horger
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D012871:Skin Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome