title: Assessment of acute intestinal graft versus host disease by abdominal magnetic resonance imaging at 3 Tesla.
abstract: OBJECTIVE
  After allogeneic stem cell transplantation (SCT), a reliable diagnosis of acute graft versus host disease (aGvHD) is essential for an early and successful treatment. It is the aim of this analysis to assess intestinal aGvHD by magnetic resonance imaging (MRI).
  
  
  METHODS
  Prior to allogeneic SCT, 64 consecutive patients underwent abdominal MRI examination on a 3 T MR system, including axial and coronal T2w sequences and a three-dimensional dynamic T1w, contrast enhanced sequence. After SCT, 20 patients with suspected aGvHD received a second MRI as well as an endoscopic examination.
  
  
  RESULTS
  Nine patients suffered from histologically proven intestinal aGvHD. In eleven patients intestinal aGvHD was excluded. In all aGvHD patients typical MRI findings with long-segment bowel wall thickening--always involving the terminal ileum--with profound submucosal oedema, were detected. The bowel wall was significantly thickened in patients with intestinal aGvHD. Bowel contrast enhancement spared the submucosa while demonstrating strong mucosal hyperemia.
  
  
  CONCLUSIONS
  In intestinal aGvHD, a characteristic MR-appearance can be detected. This MRI pattern might facilitate an early and non-invasive diagnosis of intestinal aGvHD. MRI might thus be used as a sensitive tool to rule out or support the clinical diagnosis of aGvHD.
  
  
  CONCLUSIONS
  • Acute intestinal graft versus host disease (aGvHD) can be assessed by MRI. • The aGvHD of the bowel demonstrates a characteristic MR imaging pattern. • Bowel wall shows extensive long-segment wall thickening with profound submucosal oedema. • Terminal ileum seems invariably affected; other bowel segments show variable involvement. • Colonoscopy in suspected aGvHD should include inspection of terminal ileum.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany, johannes.budjan@umm.de.
authors.forename: Johannes
authors.initials: J
authors.lastname: Budjan
authors.forename: Henrik J
authors.initials: HJ
authors.lastname: Michaely
authors.forename: Ulrike
authors.initials: U
authors.lastname: Attenberger
authors.forename: Stefan
authors.initials: S
authors.lastname: Haneder
authors.forename: Daniela
authors.initials: D
authors.lastname: Heidenreich
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kreil
authors.forename: Florian
authors.initials: F
authors.lastname: Nolte
authors.forename: Wolf-Karsten
authors.initials: WK
authors.lastname: Hofmann
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Klein
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D005770:Gastrointestinal Neoplasms / Q000628:therapy*; D006086:Graft vs Host Disease / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult