CT Features with Pathologic Correlation of Acute Gastrointestinal Graft

CT Features with Pathologic Correlation of Acute Gastrointestinal Graft

http://www.ajronline.org/cgi/content/full/181/6/1621

Babak N. Kalantari 1 ; Koenraad J. Mortelé 1 ; Vito Cantisani 1 ; Silvia Ondategui 1 ; Jonathan N. Glickman 2 ; Adheet Gogate 1 ; Pablo R. Ros 1 ; Stuart G. Silverman 1

1 Department of Radiology, Section of Abdominal Imaging and Intervention, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115.
2 Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115.
Received April 4, 2003; accepted after revision June 2, 2003.

OBJECTIVE: This study was conducted to describe the CT features of acute gastrointestinal graft-versus-host disease in adults and to correlate these findings with the pathologic grades of disease severity.

MATERIALS AND METHODS: Patients (n = 22) with a history of allogeneic bone marrow transplantation and pathologically confirmed acute gastrointestinal graft-versus-host disease underwent contrast-enhanced (n = 13) and unenhanced (n = 9) CT. CT scans were retrospectively evaluated for intestinal and extraintestinal abnormalities by two radiologists who were unaware of the biopsy results. The CT findings were correlated with the pathologic grade of disease severity using the Pearson’s correlation coefficient and the two-tailed nonparametric Spearman’s rank correlation coefficient.

RESULTS: CT features included small-bowel wall thickening (22/22), engorgement of the vasa recta adjacent to affected bowel segments (20/22), stranding of the mesenteric fat (16/22), large-bowel wall thickening (13/22), bowel dilatation proximal to thickened wall segments (5/22), ascites (10/22), periportal edema (8/22), mucosal enhancement (7/13), and serosal enhancement (4/13). The wall thickening had a discontinuous distribution in nine patients (41%). Bowel wall thickening was associated with high-grade graft-versus-host disease in patients in whom the distal esophagus (p = 0.015), ileum (p = 0.034), or ascending colon (p = 0.05) was involved. Increasing numbers of thickened bowel segments correlated with high-grade graft-versus-host disease (r = 0.548, p = 0.008). Increasing numbers of abnormal CT findings did not correlate with high-grade graft-versus-host disease (r = 0.117, p = 0.604).

CONCLUSION: A variety of bowel abnormalities can be seen on CT in patients with acute graft-versus-host disease. CT findings associated with high-grade graft-versus-host disease are thickening of the distal esophagus, ileum, or ascending colon, as well as increasing numbers of thickened bowel wall segments.