Computed tomography imaging of acute gastrointestinal graft-versus-host disease after haematopoietic stem cell transplantation in children.

Aim of the study: To evaluate computed tomography (CT) findings of gastrointestinal graft-versus-host disease (GI-GVHD) occurring in children after haematopoietic stem-cell transplantation (HSCT).

Material and methods: From February 2013 to May 2018, 225 paediatric patients underwent HSCT. Sixty-eight patients (30%) presented with clinical diagnosis of acute GI-GVHD in the first 100 days after HSCT. Thirty-five (18 girls, 17 boys; age range, 2-18 years; mean age, 10.3 years) of 68 patients had abdominopelvic CT and included in study.

Results: Intestinal CT abnormalities were present in 33 (94%) and extra-intestinal CT findings were in 30 (86%) patients. Thickening of the bowel wall was the most common finding (31 patients, 89%), which involved the small bowel in 29 patients (83%), colon in 16 patients (46%), and both in 15 patients (43%). Oesophageal wall thickening was present in three patients (9%), and gastric wall thickening was in eight patients (23%). Bowel dilatation was detected in 13 patients (37%). Mucosal enhancement of the bowel wall was observed in 28 patients (80%). The prevalence of the extra-intestinal CT findings were: periportal oedema in nine (26%), ascites in 15 (43%), wall thickening and enhancement of gall bladder in 13 (37%), pericholecystic fluid in six (17%), hepatomegaly in 13 (37%), and splenomegaly in nine (26%) patients. One patient (3%) demonstrated free intraperitoneal air due to intestinal perforation.

Conclusions: CT is useful to support the clinical diagnosis of acute GVHD in children with GI symptoms after HSCT. Radiological evaluation is important because early diagnosis and treatment affect the prognosis of GI-GVHD.