Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 10;21(1):1015.
doi: 10.1186/s12885-021-08748-x.

18F-FDG-PET-MRI for the assessment of acute intestinal graft-versus-host-disease (GvHD)

Wolfgang Roll  1 , Philipp Schindler  2 , Max Masthoff  2 , Rebecca Strotmann  3 , Jörn Albring  4 , Christian Reicherts  4 , Matthias Weckesser  3 , Benjamin Noto  2 , Matthias Stelljes  4 , Michael Schäfers #  3   5 , Georg Evers #  4
Affiliations

18F-FDG-PET-MRI for the assessment of acute intestinal graft-versus-host-disease (GvHD)

Wolfgang Roll et al. BMC Cancer. .

Abstract

Background: Graft versus host disease (GvHD) is a frequent complication of allogeneic stem cell transplantation (alloSCT), significantly increasing mortality. Previous imaging studies focused on the assessment of intestinal GvHD with contrast-enhanced MRI/CT or 18F-FDG-PET imaging alone. The objective of this retrospective study was to elucidate the diagnostic value of a combined 18F-FDG-PET-MRI protocol in patients with acute intestinal GvHD.

Methods: Between 2/2015 and 8/2019, 21 patients with acute intestinal GvHD underwent 18F-FDG-PET-MRI. PET, MRI and PET-MRI datasets were independently reviewed. Readers assessed the number of affected segments of the lower gastrointestinal tract and the reliability of the diagnosis on a 5-point Likert scale and quantitative PET (SUVmax, SUVpeak, metabolic volume (MV)) and MRI parameter (wall thickness), were correlated to clinical staging of acute intestinal GvHD.

Results: The detection rate for acute intestinal GvHD was 56.8% for PET, 61.4% for MRI and 100% for PET-MRI. PET-MRI (median Likert-scale value: 5; range: 4-5) offers a significantly higher reliability of the diagnosis compared to PET (median: 4; range: 2-5; p = 0.01) and MRI alone (median: 4; range: 3-5; p = 0.03). The number of affected segments in PET-MRI (rs = 0.677; p < 0.001) and the MV (rs = 0.703; p < 0.001) correlated significantly with the clinical stage. SUVmax (rs = 0.345; p = 0.14), SUVpeak (rs = 0.276; p = 0.24) and wall thickening (rs = 0.174; p = 0.17) did not show a significant correlation to clinical stage.

Conclusion: 18F-FDG-PET-MRI allows for highly reliable assessment of acute intestinal GvHD and adds information indicating clinical severity.

Keywords: FDG; GvHD; Inflammation; PET-MRI.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Whole body MIP (A) of an acute intestinal GvHD patient with increased 18F-FDG uptake of the colon transversum and descendens. Corresponding coronal MR images reveal mural contrast enhancement of affected large bowel segments (big and small arrow) on T1-weighted contrast enhanced images (B) and stenosis (big arrow) with prestenotic distension as shown on coronal T2-weighted imaging (C) with corresponding increased 18F-FDG uptake in fused images (D)
Fig. 2
Fig. 2
Whole-body MIP (A), contrast enhanced T1 weighted axial MRI sections (B), corresponding PET (C) and fused images (D) of a patient with acute intestinal GvHD (grade II). MR imaging shows contrast enhancement of ileal loops (thick arrow), mural stratification and hypervascular appearance of the mesentery (comb sign) (thin arrow) strongly suggesting presence of acute intestinal GvHD. 18F-FDG-PET, however, does not show increased uptake in the affected bowel segments (A,C,D)
Fig. 3
Fig. 3
Coronal MR- and fused PET-MRI images of a patient with acute intestinal GvHD. Coronal T1-weighted MRI (A) reveals mural contrast enhancement of the small bowel loops with increased 18F-FDG uptake infused images (B). Typical hypervascular appearance of the mesentery (Comb sign) (arrows) adjacent to small bowel loops affected by GvHD (C) with increased 18F-FDG uptake in fused images (D)
See this image and copyright information in PMC

References

    1. Zeiser R, Blazar BR. Acute graft-versus-host disease - biologic process, prevention, and therapy. N Engl J Med. 2017;377(22):2167–2179. doi: 10.1056/NEJMra1609337. - DOI - PMC - PubMed
    1. Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, Chanswangphuwana C, Efebera YA, Holler E, Litzow M, Ordemann R, Qayed M, Renteria AS, Reshef R, Wölfl M, Chen YB, Goldstein S, Jagasia M, Locatelli F, Mielke S, Porter D, Schechter T, Shekhovtsova Z, Ferrara JLM, Levine JE. International, multicenter standardization of acute graft-versus-host disease clinical data collection: a report from the Mount Sinai acute GVHD international consortium. Biol Blood Marrow Transplant. 2016;22(1):4–10. doi: 10.1016/j.bbmt.2015.09.001. - DOI - PMC - PubMed
    1. Fallows G, Rubinger M, Bernstein CN. Does gastroenterology consultation change management of patients receiving hematopoietic stem cell transplantation? Bone Marrow Transplant. 2001;28(3):289–294. doi: 10.1038/sj.bmt.1703130. - DOI - PubMed
    1. Scott AP, Tey S-K, Butler J, Kennedy GA. Diagnostic utility of endoscopy and biopsy in suspected acute gastrointestinal graft-versus-host disease after hematopoietic progenitor cell transplantation. Biol blood marrow Transplant J Am Soc Blood Marrow Transplant. 2018;24(6):1294–1298. doi: 10.1016/j.bbmt.2018.01.034. - DOI - PubMed
    1. Neurath MF, Vehling D, Schunk K, Holtmann M, Brockmann H, Helisch A, Orth T, Schreckenberger M, Galle PR, Bartenstein P. Noninvasive assessment of Crohn’s disease activity: a comparison of 18F-fluorodeoxyglucose positron emission tomography, hydromagnetic resonance imaging, and granulocyte scintigraphy with labeled antibodies. Am J Gastroenterol. 2002;97(8):1978–1985. doi: 10.1016/S0002-9270(02)04192-8. - DOI - PubMed

MeSH terms

Substances