Assessment of Sclerodermoid Chronic Graft-versus-host Disease with Colour Doppler Ultrasound

Abstract

Sclerodermoid chronic graft-versus-host disease (scGVHD) is a severe complication of allogeneic haema-- topoietic stem cell transplantation. The aim of this study was to investigate the usefulness of high-frequency ultrasound of the skin in assessing the inflammatory patterns and prognosis of patients with scGVHD. A prospective study was carried out with patients who developed scGVHD in the period June 2016 to April 2018. Clinical and ultrasound examinations were performed on the first visit and at 6-month follow-up. A total of 24 patients were included in the study. A 6-month follow-up high-frequency ultrasound of the skin was performed on 20 of the 24 patients. Abnormal B-mode findings in high-frequency ultrasound of the skin consisted of hypoechogenic dermis, hypoechogenicity of septa and hyperechogenicity of lobules in hypodermis. No differences were observed in these basal parameters between treatment progressive/non-responding and inactive/responding scGVHD groups of patients. Basal Doppler showing increased vascular flow with a systolic peak ≥10 cm/s and a vascular resistance index ≥ 0.70 was observed only in those patients who developed progressive/non-responding scGVHD (62.5% vs 0% p = 0.006). In conclusion, Doppler ultrasound is a useful tool to assess the inflammatory activity and outcome of scGVHD. These findings could enhance patient management and help to guide treatment decisions.

Keywords: Doppler ultrasound; allogeneic haematopoietic stem cell transplantation; diagnosis; inflammation; sclerodermoid; graft-versus-host disease.

Fig. 1

High-frequency ultrasound of normal skin. The upper image shows hypoechogenicity of the dermis, loss of dermo-hypodermal differentiation, increased hypoechogenicity and thickness of the septa, with hyperechogenicity of the lobules. The lower image shows the increased flow in color Doppler mode.

Fig. 2

Clinical status of patients and Doppler ultrasound (DU) findings at the beginning of the study and at 6 months of follow-up. DU+: Doppler ultrasound positive (systolic peaks ≥ 10 cm/s and vascular resistance index ≥ 0.70 hertz). DU– : Doppler ultrasound negative (systolic peaks <10 cm/s and vascular resistance index < 0.70 hertz).

Fig. 3

High-frequency ultrasound of skin in a patient with sclerodermoid chronic graft-versus-host-disease (scGVHD). Upper image: B-mode; lower image.