Computed tomography imaging of acute gastrointestinal graft- versus -host disease after haematopoietic stem cell transplantation in children

Abstract

Aim of the studyTo evaluate computed tomography (CT) findings of gastrointestinal graft-versus-host disease (GI-GVHD) occurring in children after haematopoietic stem-cell transplantation (HSCT).Material and methodsFrom February 2013 to May 2018, 225 paediatric patients underwent HSCT. Sixty-eight patients (30%) presented with clinical diagnosis of acute GI-GVHD in the first 100 days after HSCT. Thirty-five (18 girls, 17 boys; age range, 2–18 years; mean age, 10.3 years) of 68 patients had abdominopelvic CT and included in study.ResultsIntestinal CT abnormalities were present in 33 (94%) and extra-intestinal CT findings were in 30 (86%) patients. Thickening of the bowel wall was the most common finding (31 patients, 89%), which involved the small bowel in 29 patients (83%), colon in 16 patients (46%), and both in 15 patients (43%). Oesophageal wall thickening was present in three patients (9%), and gastric wall thickening was in eight patients (23%). Bowel dilatation was detected in 13 patients (37%). Mucosal enhancement of the bowel wall was observed in 28 patients (80%). The prevalence of the extra-intestinal CT findings were: periportal oedema in nine (26%), ascites in 15 (43%), wall thickening and enhancement of gall bladder in 13 (37%), pericholecystic fluid in six (17%), hepatomegaly in 13 (37%), and splenomegaly in nine (26%) patients. One patient (3%) demonstrated free intraperitoneal air due to intestinal perforation.ConclusionsCT is useful to support the clinical diagnosis of acute GVHD in children with GI symptoms after HSCT. Radiological evaluation is important because early diagnosis and treatment affect the prognosis of GI-GVHD.

Noninvasive imaging diagnosis of sinusoidal obstruction syndrome: a pictorial review

“…Although some clinical manifestations of GVHD are similar to that of SOS such as toxic reactions, weight gain, and deranged liver function tests; however, the distinctive features of GVHD are more often associated with inflammatory symptoms (e.g., pyrexia) and a series of skin illness (e.g., poikiloderma, nail dystrophy, and alopecia) [45]. At present, imaging studies have limitations in the diagnosis of GVHD, although some intestinal CT abnormalities have been found in acute GVHD after HCST in children [46]. BSC is an obstruction from hepatic veins to the superior end of the inferior vena cava (IVC).…”