aGvHD

EBMT 2018 | MRE for the diagnosis and staging of intestinal aGvHD

Intestinal acute graft-versus-host disease (i-aGvHD) is a serious complication during the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT). Diagnosis of i-aGvHD is based on clinical symptoms and CT imaging but endoscopic evaluation with histologic and microbiologic examination of the biopsied tissue is necessary to confirm the diagnosis. There is a paucity of data on the efficacy of magnetic resonance enterography (MRE) detecting i-aGvHD. Francesca Maccioni from Sapienza University, Rome, Italy, on behalf of her colleagues presented results of their retrospective analysis investigating the clinical significance of MRE in i-aGvHD diagnosis during an oral abstract session at the 44th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT), Lisbon, Portugal, on Wednesday 21 March 2018.

Thirty-five patients (age = 9-69 years) who had suspected i-aGvHD and had a MRE exam between 2015-2017 were included in the analysis. 1.5 Tesla scanner (Siemens, MagnetomAvanto) with 16-channels phased-array coils was used to perform the test.

To accurately assess the severity of i-aGvHD, a score system for all intestinal segments (from stomach to rectum) was implemented based on the following factors:

  • Inflammation-activity: mural T2 signal (oedema), mesenteric T2 signal (oedema), gadolinium wall enhancement on T1 (vascularity), DWI signal (inflammation)
  • Morphologic parameters: maximum wall thickness, increased number and/or size of local mesenteric lymph nodes, comb sign (mesenteric vessels dilation), presence of peritoneal effusion1
Key findings:
  • 21 patients had histologically confirmed i-aGvHD
  • Observed MRE parameters:
    • Stratified mucosal wall enhancement after gadolinium injection: 90% of patients
    • Parietal enhancement was associated with high-grade oedema of mesenteric fat tissue and comb sign: 76% of patients
    • Mesenteric lymph nodes were not shown: 52.4% of patients
    • Free intra-peritoneal fluid: 57.2% of patients
    • Most commonly involved intestinal segments:
      • distal ileum (85.7%)
      • mean ileum (66.6%)
      • proximal ileum (57.1%)
      • ascending colon and sigmoid equally (38%)
    • Significant association was found between clinical stage of i-aGVHD and mural T2 signal, number of involved intestinal segments, wall thickness, T1 enhancement, and peritoneal effusion, P < 0.001

Francesca Maccioni concluded her talk by highlighting that MRE is efficient in terms of diagnosis of i-aGvHD. She further added that “this technic should be considered to replace invasive methods like endoscopic biopsy.”

References
  1. Maccioni F. et al. Multiparametric magnetic resonance enterography for the diagnosis and staging of intestinal acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation. OS16-4. 2018 March 21. 44th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT). Lisbon, Portugal.
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