OBJECTIVES: 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. KEY POINTS: • 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.
OBJECTIVES: 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. KEY POINTS: • 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: Fiona L Dignan; Andrew Clark; Persis Amrolia; Jacqueline Cornish; Graham Jackson; Prem Mahendra; Julia J Scarisbrick; Peter C Taylor; Nedim Hadzic; Bronwen E Shaw; Michael N Potter Journal: Br J Haematol Date: 2012-04-26 Impact factor: 6.998
Authors: S A Klein; H Martin; D Schreiber-Dietrich; S Hermann; W F Caspary; D Hoelzer; C F Dietrich Journal: Br J Haematol Date: 2001-12 Impact factor: 6.998
Authors: Marco Mielcarek; Paul J Martin; Wendy Leisenring; Mary E D Flowers; David G Maloney; Brenda M Sandmaier; Michael B Maris; Rainer Storb Journal: Blood Date: 2003-03-27 Impact factor: 22.113
Authors: G J Cox; S M Matsui; R S Lo; M Hinds; R A Bowden; R C Hackman; W G Meyer; M Mori; P I Tarr; L S Oshiro Journal: Gastroenterology Date: 1994-11 Impact factor: 22.682
Authors: H Brodoefel; W Bethge; M Vogel; M Fenchel; C Faul; M Wehrmann; C Claussen; M Horger Journal: Eur J Radiol Date: 2009-02-06 Impact factor: 3.528
Authors: Babak N Kalantari; Koenraad J Mortelé; Vito Cantisani; Silvia Ondategui; Jonathan N Glickman; Adheet Gogate; Pablo R Ros; Stuart G Silverman Journal: AJR Am J Roentgenol Date: 2003-12 Impact factor: 3.959