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Open Access 01-12-2021 | Magnetic Resonance Imaging | Research

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

Authors: Wolfgang Roll, Philipp Schindler, Max Masthoff, Rebecca Strotmann, Jörn Albring, Christian Reicherts, Matthias Weckesser, Benjamin Noto, Matthias Stelljes, Michael Schäfers, Georg Evers

Published in: BMC Cancer | Issue 1/2021

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 (r_s = 0.677; p < 0.001) and the MV (r_s = 0.703; p < 0.001) correlated significantly with the clinical stage. SUVmax (r_s = 0.345; p = 0.14), SUVpeak (r_s = 0.276; p = 0.24) and wall thickening (r_s = 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.

Zeiser R, Blazar BR. Acute graft-versus-host disease - biologic process, prevention, and therapy. N Engl J Med. 2017;377(22):2167–79. https://doi.org/10.1056/NEJMra1609337.CrossRefPubMedPubMedCentral

Harris AC, Young R, Devine S, Hogan WJ, Ayuk F, Bunworasate U, et al. 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. https://doi.org/10.1016/j.bbmt.2015.09.001.CrossRefPubMed

Fallows G, Rubinger M, Bernstein CN. Does gastroenterology consultation change management of patients receiving hematopoietic stem cell transplantation? Bone Marrow Transplant. 2001;28(3):289–94. https://doi.org/10.1038/sj.bmt.1703130.CrossRefPubMed

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):1294–8. https://doi.org/10.1016/j.bbmt.2018.01.034.CrossRef

Neurath MF, Vehling D, Schunk K, Holtmann M, Brockmann H, Helisch A, et al. 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):1978–85. https://doi.org/10.1016/S0002-9270(02)04192-8.CrossRefPubMed

Löffler M, Weckesser M, Franzius C, Schober O, Zimmer KP. High diagnostic value of 18F-FDG-PET in pediatric patients with chronic inflammatory bowel disease. Ann N Y Acad Sci. 2006;1072(1):379–85. https://doi.org/10.1196/annals.1326.014.CrossRefPubMed

Li Y, Beiderwellen K, Nensa F, Grüneisen J, Dobos G, Herrmann K, et al. [18F] FDG PET/MR enterography for the assessment of inflammatory activity in Crohn’s disease: comparison of different MRI and PET parameters. Eur J Nucl Med Mol Imaging. 2018;45(8):1382–93. https://doi.org/10.1007/s00259-018-3962-y.CrossRefPubMed

Dejanovic D, Amtoft A, Loft A. 18 F-FDG PET/CT in extensive graft-versus-host disease of the gastrointestinal tract following autologous stem cell transplantation. Diagnostics. 2018;8(4):72. https://doi.org/10.3390/diagnostics8040072.CrossRefPubMedCentral

Taylor SA, Mallett S, Bhatnagar G, Baldwin-Cleland R, Bloom S, Gupta A, et al. Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol. 2018;3(8):548–58. https://doi.org/10.1016/S2468-1253(18)30161-4.CrossRefPubMedPubMedCentral

10.

Brodoefel H, Bethge W, Vogel M, Fenchel M, Faul C, Wehrmann M, et al. Early and late-onset acute GvHD following hematopoietic cell transplantation: CT features of gastrointestinal involvement with clinical and pathological correlation. Eur J Radiol. 2010;73(3):594–600. https://doi.org/10.1016/j.ejrad.2009.01.011.CrossRefPubMed

11.

Derlin T, Laqmani A, Veldhoen S, Apostolova I, Ayuk F, Adam G, et al. Magnetic resonance enterography for assessment of intestinal graft-versus-host disease after allogeneic stem cell transplantation. Eur Radiol. 2015;25(5):1229–37. https://doi.org/10.1007/s00330-014-3503-4.CrossRefPubMed

12.

Stelljes M, Hermann S, Albring J, Köhler G, Löffler M, Franzius C, et al. Clinical molecular imaging in intestinal graft-versus-host disease: mapping of disease activity, prediction, and monitoring of treatment efficiency by positron emission tomography. Blood. 2008;111(5):2909–18. https://doi.org/10.1182/blood-2007-10-119164.CrossRefPubMed

13.

Bodet-Milin C, Lacombe M, Malard F, Lestang E, Cahu X, Chevallier P, et al. 18 F-FDG PET/CT for the assessment of gastrointestinal GVHD: results of a pilot study. Bone Marrow Transplant. 2014;49(1):131–7. https://doi.org/10.1038/bmt.2013.144.CrossRefPubMed

14.

Assmann JC, Farthing DE, Saito K, Maglakelidze N, Oliver B, Warrick KA, et al. Glycolytic metabolism of pathogenic T cells enables early detection of GVHD by 13C-MRI. Blood. 2021;137(1):126–37. https://doi.org/10.1182/blood.2020005770.CrossRefPubMedPubMedCentral

15.

Büther F, Noto B, Auf der Springe K, Allkemper T, Stegger L. An artefact of PET attenuation correction caused by iron overload of the liver in clinical PET-MRI. Eur J Hybrid Imaging. 2017;1(1):10. https://doi.org/10.1186/s41824-017-0015-x.CrossRefPubMed

16.

Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors. J Nucl Med. 2009;50(Suppl_1):122S–50S. https://doi.org/10.2967/jnumed.108.057307.CrossRefPubMed

17.

Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 1974;18(4):295–304. https://doi.org/10.1097/00007890-197410000-00001.CrossRefPubMed

18.

Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. 1994 consensus conference on acute GVHD grading. Bone Marrow Transplant. 1995;15(6):825–8.PubMed

19.

Bombí JA, Nadal A, Carreras E, Ramírez J, Muñoz J, Rozman C, et al. Assessment of histopathologic changes in the colonic biopsy in acute graft-versus-host disease. Am J Clin Pathol. 1995;103(6):690–5. https://doi.org/10.1093/ajcp/103.6.690.CrossRefPubMed

20.

Vogelsang GB, Lee L, Bensen-Kennedy DM. Pathogenesis and treatment of graft-versus-host disease after bone marrow transplant. Annu Rev Med. 2003;54(1):29–52. https://doi.org/10.1146/annurev.med.54.101601.152339.CrossRefPubMed

21.

Schoemans HM, Lee SJ, Ferrara JL, Wolff D, Levine JE, Schultz KR, et al. EBMT-NIH-CIBMTR task force position statement on standardized terminology & guidance for graft-versus-host disease assessment. Bone Marrow Transplant. 2018;53(11):1401–15. https://doi.org/10.1038/s41409-018-0204-7.CrossRefPubMedPubMedCentral

22.

Stelljes M, Schäfers M. From the inside: GVHD and glucose metabolism. Blood. 2021;137(1):11–2. https://doi.org/10.1182/blood.2020008541.CrossRefPubMed

23.

Budjan J, Michaely HJ, Attenberger U, Haneder S, Heidenreich D, Kreil S, et al. Assessment of acute intestinal graft versus host disease by abdominal magnetic resonance imaging at 3 tesla. Eur Radiol. 2014;24(8):1835–44. https://doi.org/10.1007/s00330-014-3224-8.CrossRefPubMed

24.

Li Y, Schaarschmidt B, Umutlu L, Forsting M, Demircioglu A, Koch AK, et al. 18F-FDG PET-MR enterography in predicting histological active disease using the Nancy index in ulcerative colitis: a randomized controlled trial. Eur J Nucl Med Mol Imaging. 2020;47(4):768–77. https://doi.org/10.1007/s00259-019-04535-w.CrossRefPubMed

25.

Shih I-L, Wei S-C, Yen R-F, Chang C-C, Ko C-L, Lin B-R, et al. PET/MRI for evaluating subclinical inflammation of ulcerative colitis. J Magn Reson Imaging. 2018;47(3):737–45. https://doi.org/10.1002/jmri.25795.CrossRefPubMed

26.

Kalantari BN, Mortelé KJ, Cantisani V, Ondategui S, Glickman JN, Gogate A, et al. CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults. Am J Roentgenol. 2003;181(6):1621–5. https://doi.org/10.2214/ajr.181.6.1811621.CrossRef

Title: 18F-FDG-PET-MRI for the assessment of acute intestinal graft-versus-host-disease (GvHD)
Authors: Wolfgang Roll
Philipp Schindler
Max Masthoff
Rebecca Strotmann
Jörn Albring
Christian Reicherts
Matthias Weckesser
Benjamin Noto
Matthias Stelljes
Michael Schäfers
Georg Evers
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Graft-Versus-Host Disease
Positron Emission Tomography
Graft-Versus-Host Disease
Published in: BMC Cancer / Issue 1/2021
Electronic ISSN: 1471-2407
DOI: https://doi.org/10.1186/s12885-021-08748-x

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