Abstract
Acute gastrointestinal (GI) graft-versus-host disease (GvHD) is a life-threating complication in patients after allogeneic stem cell transplantation (ASCT). In 60 sonographic analyses, a novel scoring system for non-invasive diagnosis of severe GI GvHD was developed. The score comprised morphological and vascular changes using B-mode and color-coded Doppler sonography, changes of mural stiffness using compound elastography, and dynamic microvascularisation using contrast-enhanced ultrasound (CEUS). Furthermore, inflammatory parameters such as CRP, Calprotectin, and regenerating islet-derived protein 3α (Reg3α) were obtained. ROC curve analysis of our novel GvHD sum score revealed an area under the curve of 1.0 (95% CI: 0.99–1.00) in diagnosing GI GvHD and 0.88 (95% CI: 0.79–0.96) for severe GI GvHD. A sum score above 5 correlated with GI GvHD with a sensitivity of 97.6% (41/42) and a specificity of 94.4% (17/18) and score values above 10 with severe GI GvHD with a sensitivity of 91.7% (11/12) and specificity of 79.2% (38/48). The additional use of inflammatory parameters did not improve the predictive power. CEUS is a promising, non-invasive tool for the diagnosis of acute GI GvHD. Together with further descriptive parameters for inflammatory processes, it gains significant diagnostic accuracy in identifying patients with severe stages of acute intestinal GvHD.
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Acknowledgements
Authors acknowledge the help of Heike Bremm, Constanze Winter, Tatjana Schifferstein and Yvonne Schumann in collecting and cryopreserving patient specimens as well as Heike Bremm in performing Reg3α PCR analyses.
Author contributions
D. Weber, E-MJ, and EH were involved in conception and design of the study. E-MJ and D. Weber performed ultrasound examinations including CEUS. D. Weber was responsible for collection of specimens and clinical patient data. SG was responsible for PCR-analysis of Reg3α. KH performed histopathological analysis of patient biopsies. MW contributed to statistical data analysis. D. Weber and EH collected and analyzed clinical data and wrote the manuscript. WH, D. Wolff, and E-MJ were involved in interpretation and discussion of study results according to the current literature. All authors read, revised, and approved the final draft.
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Weber, D., Weber, M., Hippe, K. et al. Non-invasive diagnosis of acute intestinal graft-versus-host disease by a new scoring system using ultrasound morphology, compound elastography, and contrast-enhanced ultrasound. Bone Marrow Transplant 54, 1038–1048 (2019). https://doi.org/10.1038/s41409-018-0381-4
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DOI: https://doi.org/10.1038/s41409-018-0381-4
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