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

By Anna Bartus

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Mar 26, 2018


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