Department of Diagnostic Radiology, Eberhard-Karls-University, 72076 Tübingen, Germany.
Eur J Radiol. 2010 Mar;73(3):594-600. doi: 10.1016/j.ejrad.2009.01.011. Epub 2009 Feb 6.
With the introduction of non-myeloablative hematopoietic cell transplantation, acute graft-versus-host-disease (GvHD) is frequently observed beyond the traditional 100 days cut-off. The aim of this study was to describe and compare CT features of gastrointestinal early and late-onset GvHD and to correlate findings with clinical and pathology grading.
Abdominal CT scans were obtained in 20 patients with early and 15 with late-onset GvHD. Examinations were assessed for intestinal and extraintestinal abnormalities and findings compared between the two subgroups of GvHD. Distinct CT abnormalities as well as a CT-score integrating multiple pathologies were correlated with gut, clinical or pathology grading.
Frequent intestinal abnormalities included wall thickening, abnormal enhancement, and excessive fluid-filling (94%, 89%, and 94%). 86% of patients showed concomitant small and large bowel involvement. A discontinuous distribution was observed in 54%. Bile tract abnormality was the most common extra-intestinal finding (74%). The distribution of pathologies was equal between subgroups of early or late-onset disease. Wall thickening and mucosal attenuation in non-enhanced scans were significantly related to clinical and pathology scores (P</=0.018). Number of abnormal segments, small bowel dilatation, engorgement of the vasa recta, mesenteric fat stranding and ascites were linked to clinical grading (P</=0.019). A CT-score integrating multiple abnormalities was correlated to gut, overall clinical and pathology grading (r=0.64, 0.57, 0.50).
CT morphology of acute GvHD is independent of its time of onset and, thus, facilitates differential diagnosis of late-onset acute GvHD. Correlation of CT morphology with clinical and pathological grading is important in terms of prognosis and may help guiding the therapeutic approach.
随着非清髓性造血细胞移植的引入，急性移植物抗宿主病（GvHD）经常在传统的 100 天截止期之后发生。本研究的目的是描述和比较胃肠道早期和晚期 GvHD 的 CT 特征，并将发现与临床和病理学分级相关联。
对 20 例早期 GvHD 患者和 15 例晚期 GvHD 患者进行了腹部 CT 扫描。评估了肠道和肠道外异常的情况，并比较了两组 GvHD 的检查结果。将不同的 CT 异常以及整合多种病理学的 CT 评分与肠道、临床或病理学分级相关联。
常见的肠道异常包括壁增厚、异常强化和过度积液（94%、89%和 94%）。86%的患者同时累及小肠和大肠。54%的患者观察到不连续的分布。胆道异常是最常见的肠道外表现（74%）。早发性或迟发性疾病亚组之间的病理学分布相等。非增强扫描时的壁增厚和黏膜衰减与临床和病理学评分显著相关（P</=0.018）。异常节段数、小肠扩张、直肠血管充盈、肠系膜脂肪条纹和腹水与临床分级相关（P</=0.019）。整合多种异常的 CT 评分与肠道、整体临床和病理学分级相关（r=0.64、0.57、0.50）。
急性 GvHD 的 CT 形态与其发病时间无关，因此有助于鉴别诊断迟发性急性 GvHD。CT 形态与临床和病理学分级的相关性对于预后很重要，并且可能有助于指导治疗方法。
