Imaging of Abdominal and Pelvic Manifestations of Graft-Versus-Host Disease After Hematopoietic Stem Cell Transplant

Abstract

GVHD is a serious complication of HSCT, which involves multiple organ systems, with imaging manifestations most commonly seen in the gastrointestinal tract and hepatobiliary system. Knowledge of the imaging manifestations of GVHD, which alone may be relatively nonspecific, taken in conjunction with clinical history including the timing and type of HSCT, laboratory values, stool studies, and dermatologic findings can increase radiologist confidence in suggesting this diagnosis.

CT Findings of Acute Small-Bowel Entities

“…In contrast to other causes of acute enteritis discussed here, GVHD more often involves the small bowel diffusely and may involve the colon (39). In chronic disease, bowel wall thickening can be conspicuously absent at imaging, while dilated fluid-filled loops of featureless small bowel have been described (41).…”

“…GVHD can affect the entire length of the gastrointestinal tract, from the esophagus to the rectum. A number of findings may precede the gastrointestinal manifestations, including hepatosplenomegaly, gallbladder wall thickening, and most notably, a diffuse pruritic maculopapular rash (39). The most common CT features, other than small-bowel wall thickening, include engorgement of the vasa recta, mesenteric fat stranding, and circumferential thickening of the colon (39,40).…”

“…The chronicity and temporal course of findings in GVHD are the subjects of much scrutiny and have been analyzed by a National Institutes of Health working group (38). In acute disease, GVHD often manifests at intravenous contrast-enhanced CT with fluid-filled loops of avidly enhancing small bowel (target sign), with distinct separation of bowel loops (39).…”

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

“…Graft-versus-host disease (GVHD) is one of the most serious complications, with an average incidence of 59% after HSCT. GVHD is an immunological disease that occurs due to the relation between T lymphocytes of the donor and epithelial cells of the recipient [ 2 ]. The skin, gastrointestinal (GI) tract, and liver are the most commonly involved organs [ 3 ].…”

“…However, typical imaging features are present in the GI and hepatobiliary system. Awareness of these imaging findings is essential for early diagnosis and appropriate treatment to reduce morbidity and mortality of the GI-GVHD [ 2 ]. Abdominopelvic computed tomography (CT) is the primary imaging modality to determine abnormal findings in GI-GVHD [ 6 ].…”