Ultrasonographic evaluation of gastrointestinal graft‐versus‐host disease after hematopoietic stem cell transplantation

Gastrointestinal graft-versus-host disease (GI-GVHD) is a major and life-threatening complication of hematopoietic stem cell transplantation (HSCT). This study evaluated the efficacy of ultrasonography (US) for assessing and monitoring GI-GVHD. GI tract was evaluated by US in 81 patients. US findings were positive in 43 patients, including 11 false positive, and negative in 38 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US for the diagnosis of GI-GVHD were 100%, 78%, 74%, 100%, and 86%, respectively. Diffuse wall thickening of the ileum was the most frequent finding in patients with GI-GVHD. Severity of GI-GVHD was correlated with the thickness of internal low echoic layer of the wall, the echogenicity of mesenteric fat tissue, and the intensity of Doppler signaling. We classified US findings of GI-GVHD into four US grades. There was a significant correlation between clinical stage of GI-GVHD and the US grade. These ultrasonographic abnormalities were improved with clinical improvement of GI-GVHD upon treatment. Thus, US is an effective and efficient non-invasive means of identifying the extent and severity of GI-GVHD and monitoring response to treatment.