Early post-transplant contrast-enhanced abdominopelvic CT scan predicts the risk of subsequent acute GvHD

Rashidi, Armin; Lin, Michael; Cashen, Amanda F.

doi:10.1038/bmt.2015.232

Cited by 8 publications

(5 citation statements)

References 20 publications

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“…Further stratification of the lower-risk group will likely be available in the future on larger series. Thus far, only few studies have investigated the role of imaging in the diagnosis of intestinal GVHD, most of them performed with CT, very few with MRI [19][20][21][22][23][24][25][26][27][28]. Currently, however, MRI Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Fifteen different MRI parameters were considered to be suggestive of intestinal and/or peritoneal inflammation and preselected to assess the severity of the GI-aGVHD on the basis of previous studies on GVHD [17][18][19][20][21][22][23][24][25][26][27][28], previous studies on IBD [30][31][32][33], and our team experience. Once one or more pathological intestinal segments were identified, their location was reported on a database, their length measured, and each single parameter assessed.…”

Section: Image Analysismentioning

confidence: 99%

“…In this difficult clinical setting, imaging can play an important role. Most published studies are based on CT, ultrasound, and more recently PET [17][18][19][20][21][22][23][24][25], whereas few data exist on magnetic resonance imaging (MRI) [26][27][28]. However, MRI is nowadays considered an effective tool for the diagnosis of inflammatory bowel diseases [29,30], and is regarded as the gold standard for monitoring disease activity in Crohn's disease [31][32][33][34].…”

Section: Introductionmentioning

confidence: 99%

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Multi-parametric MRI in the diagnosis and scoring of gastrointestinal acute graft-versus-host disease

et al. 2023

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Objectives Acute gastrointestinal graft-versus-host disease (GI-aGVHD) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT). Diagnosis relies on clinical, endoscopic, and pathological investigations. Our purpose is to assess the value of magnetic resonance imaging (MRI) in the diagnosis, staging, and prediction of GI-aGVHD-related mortality. Methods Twenty-one hematological patients who underwent MRI for clinical suspicion of acute GI-GVHD were retrospectively selected. Three independent radiologists, blinded to the clinical findings, reanalyzed MRI images. The GI tract was evaluated from stomach to rectum by analyzing fifteen MRI signs suggestive of intestinal and peritoneal inflammation. All selected patients underwent colonoscopy with biopsies. Disease severity was determined on the basis of clinical criteria, identifying 4 stages of increasing severity. Disease-related mortality was also assessed. Results The diagnosis of GI-aGVHD was histologically confirmed with biopsy in 13 patients (61.9%). Using 6 major signs (diagnostic score), MRI showed 84.6% sensitivity and 100% specificity in identifying GI-aGVHD (AUC = 0.962; 95% confidence interval 0.891–1). The proximal, middle, and distal ileum were the segments most frequently affected by the disease (84.6%). Using all 15 signs of inflammation (severity score), MRI showed 100% sensitivity and 90% specificity for 1-month related mortality. No correlation with the clinical score was found. Conclusion MRI has proved to be an effective tool for diagnosing and scoring GI-aGVHD, with a high prognostic value. If larger studies will confirm these results, MRI could partly replace endoscopy, thus becoming the primary diagnostic tool for GI-aGVHD, being more complete, less invasive, and more easily repeatable. Key Points • We have developed a new promising MRI diagnostic score for GI-aGVHD with a sensitivity of 84.6% and specificity of 100%; results are to be confirmed by larger multicentric studies. • This MRI diagnostic score is based on the six MRI signs most frequently associated with GI-aGVHD: small-bowel inflammatory involvement, bowel wall stratification on T2-w images, wall stratification on post-contrast T1-w images, ascites, and edema of retroperitoneal fat and declivous soft tissues. • A broader MRI severity score based on 15 MRI signs showed no correlation with clinical staging but high prognostic value (100% sensitivity, 90% specificity for 1-month related mortality); these results also need to be confirmed by larger studies.

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Section: Discussionmentioning

confidence: 99%

Section: Image Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multi-parametric MRI in the diagnosis and scoring of gastrointestinal acute graft-versus-host disease

et al. 2023

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“…We propose DeltaAlb as an early biomarker of gut damage (with mucotoxic ablative conditioning regimens such as Bu/Cy or Cy/TBI) that could be further investigated along with the growing list of other recently reported early predictive biomarkers [15,[21][22][23][24]. No single early biomarker is likely to be an adequate predictor of aGVHD risk.…”

Section: Discussionmentioning

confidence: 99%

Peritransplant Serum Albumin Decline Predicts Subsequent Severe Acute Graft-versus-Host Disease after Mucotoxic Myeloablative Conditioning

Rashidi

DiPersio

Westervelt

et al. 2016

Biology of Blood and Marrow Transplantation

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Conditioning-related gut toxicity can result in a protein-losing enteropathy manifesting as a decline in serum albumin in the peritransplant period. Inspired by the pathogenesis of acute graft-versus-host disease (aGVHD), we hypothesized that the magnitude of decline in serum albumin from the day of conditioning initiation until its nadir in the first 2 weeks after hematopoietic cell transplantation HCT (DeltaAlb) predicts the risk for subsequent severe aGVHD. We reviewed the medical records of all 88 patients with acute myeloid leukemia or myelodysplastic syndrome who underwent highly mucotoxic myeloablative (busulfan/cyclophosphamide or cyclophosphamide/total body irradiation) allogeneic HCT from a matched related donor (MRD) or matched unrelated donor (MUD) at our institution between January 1, 2012 and January 1, 2015. Severe aGVHD was associated with MUD (47% versus 14% with MRD; P = .001) and DeltaAlb, which was significantly greater among patients who developed versus did not develop severe aGVHD (1.2 ± .5 versus .8 ± .4 g/dL, respectively; P < .001). In multivariate analysis DeltaAlb remained a significant predictor of severe aGVHD (odds ratio, 5.68; 95% CI, 1.65 to 19.64; P = .006; area under the ROC curve, .74; 95% CI, .63 to .86; P < .001). The best cutoff for DeltaAlb to predict severe aGVHD was .9, with a sensitivity, specificity, and overall classification accuracy of 77%, 66%, and 69%, respectively. The model was validated using the bootstrap technique, with no significant change in its performance. These results were not generalizable to a cohort of 30 patients who received less mucotoxic myeloablative or reduced-intensity conditioning. In conclusion, with mucotoxic myeloablative HCT, each .1-g/dL increase in DeltaAlb was associated with an approximately 23% increase in the odds of developing severe aGVHD. As an early biomarker of gut damage, DeltaAlb can be incorporated in composite risk models for aGVHD prediction, with hopes for ultimately allowing for individualized GVHD prophylaxis and potential intervention according to the predicted risk.

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“…1 Flow chart of patient screening attenuation of contrast-enhanced scans of uncontracted segments compared to nearby normal small bowel segments), division of the GI tract into 10 segments (stomach, duodenum, jejunum, ileum, cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum), and counting the number of involved bowel collaterals (multifocal intestinal wall inflammation was defined as the involvement of ≥ 3 groups of bowel collaterals) (Fig. 2A, B); (2) intestinal wall thickening (measuring the thickest part of the most distended segment or the most severe inflammatory site): grading of gastric wall thickening was categorized as normal (< 4 mm), mild (4-6 mm), moderate (6-9 mm), and severe (> 9 mm), grading of small bowel wall thickening was categorized as normal (< 2 mm), mild (2-3 mm), moderate (3-5 mm), and severe (> 5 mm), and grading of colonic wall thickening was categorized as normal (< 5 mm), mild (5-7 mm), moderate (7-10 mm), and severe (> 10 mm) [13]; as shown in Fig. 2C, the case exhibited severe thickening of the sigmoid colon; (3) the circular target sign was defined as a bilaminar shape of the intestinal wall based on a high degree of mucosal enhancement and a reduced intramural attenuation [14] (Fig.…”

Section: Ct Image Analysismentioning

confidence: 99%

Diagnostic prediction of gastrointestinal graft-versus-host disease based on a clinical- CT- signs nomogram model

Feng,

Xu,

Guan

et al. 2024

Insights Imaging

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Objective Gastrointestinal graft-versus-host disease (GI-GVHD) is one of the complications that can easily occur after hematopoietic stem cell transplantation (HSCT). Timely diagnosis and treatment are pivotal factors that greatly influence the prognosis of patients. However, the current diagnostic method lacks adequate non-invasive diagnostic tools. Methods A total of 190 patients who suspected GI-GVHD were retrospectively included and divided into training set (n = 114) and testing set (n = 76) according to their discharge time. Least absolute shrinkage and selection operator (LASSO) regression was used to screen for clinically independent predictors. Based on the logistic regression results, both computed tomography (CT) signs and clinically independent predictors were integrated in order to build the nomogram, while the testing set was verified independently. The receiver operating characteristic (ROC), area under the curve (AUC), decision curve, and clinical impact curve were used to measure the accuracy of prediction, clinical net benefit, and consistency of diagnostic factors. Results Four key factors, including II-IV acute graft-versus-host disease (aGVHD), the circular target sign, multifocal intestinal inflammation, and an increased in total bilirubin, were identified. The combined model, which was constructed from CT signs and clinical factors, showed higher predictive performances. The AUC, sensitivity, and specificity of the training set were 0.867, 0.787, and 0.811, respectively. Decision curve analysis (DCA), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) showed that the developed model exhibited a better prediction accuracy than the others. Conclusions This combined model facilitates timely diagnosis and treatment and subsequently improves survival and overall outcomes in patients with GI-GVHD. Critical relevance statement GI-GVHD is one of the complications that can easily occur after HSCT. However, the current diagnostic approach lacks adequate non-invasive diagnostic methods. This non-invasive combined model facilitates timely treatment and subsequently improves patients with GI-GVHD survival and overall outcomes. Key points • There is currently lacking of non-invasive diagnostic methods for GI-GVHD. • Four clinical CT signs are the independent predictors for GI-GVHD. • Association between the CT signs with clinical factors may improve the diagnostic performance of GI-GVHD. Graphical Abstract

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Early post-transplant contrast-enhanced abdominopelvic CT scan predicts the risk of subsequent acute GvHD

Cited by 8 publications

References 20 publications

Multi-parametric MRI in the diagnosis and scoring of gastrointestinal acute graft-versus-host disease

Multi-parametric MRI in the diagnosis and scoring of gastrointestinal acute graft-versus-host disease

Peritransplant Serum Albumin Decline Predicts Subsequent Severe Acute Graft-versus-Host Disease after Mucotoxic Myeloablative Conditioning

Diagnostic prediction of gastrointestinal graft-versus-host disease based on a clinical- CT- signs nomogram model

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