Jones B, Kramer S S, Saral R, Beschorner W E, Yolken R H, Townsend T R, Yeager A M, Lake A, Tutschka P, Santos G W
Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins Medical Institutions, Baltimore, MD 21205.
AJR Am J Roentgenol. 1988 Feb;150(2):277-81. doi: 10.2214/ajr.150.2.277.
Gastrointestinal inflammation after allogeneic bone marrow transplantation may be due to acute graft-versus-host disease (GVHD) and/or superinfection with opportunistic organisms. Twenty-eight patients with barium studies suggesting gastrointestinal inflammation after bone marrow transplantation and either acute GVHD, viral infection, or both were studied to characterize the radiographic appearances of each disease and to determine whether acute GVHD could be distinguished from viral superinfection on the basis of radiographic findings. Thirteen patients had minimal or no acute GVHD, with viral infection proved in eight and strongly suspected in four others; the remaining patient was thought to have nonspecific inflammatory bowel disease. Five patients had pure acute GVHD, and 10 patients had viral enteritis superimposed on acute GVHD. Radiographic abnormalities were found in the gastrointestinal tract in both acute GVHD and viral infection and were more extensive than previously reported. Findings were similar in both entities, although gastric abnormalities were not seen in pure acute GVHD but only in viral infection, either alone or together with acute GVHD. Prolonged small bowel barium coating occurred in both viral infection and acute GVHD. Fold thickening evolved into fold effacement with a shaggy contour in two patients with viral infection. Colonic findings in all groups mimicked ulcerative colitis. Our data indicate that differentiation between acute GVHD and viral enteritis is not possible on the basis of radiographic findings alone. Both entities should be considered when gastrointestinal inflammation occurs after bone marrow transplantation.
异基因骨髓移植后胃肠道炎症可能是由于急性移植物抗宿主病（GVHD）和/或机会性生物体的重叠感染。对28例经钡剂检查提示骨髓移植后胃肠道炎症且伴有急性GVHD、病毒感染或两者皆有的患者进行研究，以描述每种疾病的影像学表现，并确定能否根据影像学结果将急性GVHD与病毒重叠感染区分开来。13例患者急性GVHD轻微或无，其中8例证实有病毒感染，另外4例高度怀疑有病毒感染；其余1例患者被认为患有非特异性炎症性肠病。5例患者仅有急性GVHD，10例患者在急性GVHD基础上合并病毒性肠炎。急性GVHD和病毒感染患者的胃肠道均有影像学异常，且比先前报道的更为广泛。尽管单纯急性GVHD未发现胃部异常，仅在病毒感染（单独或合并急性GVHD）时出现，但两者的表现相似。病毒感染和急性GVHD患者均出现小肠钡剂长时间涂布。2例病毒感染患者出现皱襞增厚，进而发展为轮廓不规则的皱襞消失。所有组的结肠表现均类似溃疡性结肠炎。我们的数据表明，仅根据影像学结果无法区分急性GVHD和病毒性肠炎。骨髓移植后出现胃肠道炎症时，应同时考虑这两种情况。
