Ultrasound and contrast enhanced ultrasound sonography evaluation of intestinal acute graft-vs-host disease

Abstract

SUMMARY Intestinal acute graft-vs-host disease (I-GVHD) is a life-threatening complication after allografting. Non-invasive bedside procedures to evaluate extension and treatment response are still lacking. Standard ultrasound sonography (US) detects bowel wall thickening (BWT) in I-GVHD and helps to identify its extension (single or multiple sites at once). Color doppler US detects blood flow at arterioles level. Contrast-enhanced ultrasound sonography (CEUS) can detect microcirculation changes (MVC) of the bowel wall at capillary level, real time, and even bedside. CEUS allows evaluating, with dedicated software, quantitatively wash-in and washout curves of blood flowing through the thickened bowel wall, giving time intensity curves, which help to monitor treatment response as for Chron’s disease. Patients with I-GVHD with clinical relevant improvement may still have quiescent active disease. CEUS allows identifying, qualitatively and quantitatively, patients with I-GVHD with clinical improvement but with still active disease.