Diagnosing acute intestinal graft-versus-host disease by a non-invasive method: transabdominal ultrasonography and colour doppler imaging

Abstract Abstract 2327 Background: Calprotectin is a major cytosolic protein of neutrophils that have showed to be a sensitive marker of intestinal inflammation. The aim of our study has been to evaluate fecal calprotectin (FC) as a diagnosis tool in patients with acute gastrointestinal graft versus host disease (GI GVHD). Methods: Since March 2009, patients with suspicion of acute GI GVHD were consecutively included. Patients were tested for FC (reference range: 0–30 mg/kg) before starting treatment. Infections by Clostridium difficile, cytomegalovirus, fecal bacteria and intestinal parasites were also excluded. Colonoscopy was performed in all patients and biopsy samples were taken for histopathological examination. Results: To date, eleven patients have been included. The median age was 48.2 (r: 21–67). Indications for transplantation included acute myeloid leukemia (6 patients), myelodysplastic syndrome (2 patients), acute lymphoid leukemia, severe aplastic anemia and refractory follicular lymphoma (1 patient, respectively). Ten patients received myeloablative conditioning and one received reduced intensity conditioning regimen. Five patients were histologically diagnosed with acute GI GVHD. The median for FC in this group was 510.5 (r: 107.4–629). The median of FC in patients without GI GVHD was 117 (r: 13.9–205). Patients with GI GVHD had higher values of FC than patients without GI GVHD (p:≤0,009) For a cut-off point value of 205, sensitivity for the test was 83.3% (IC 61.3–100%), specificity was 100%, positive predictive value was 100%, and negative predictive value was 83.3% (IC 61.3–100%). In 3 patients who were diagnosed with cytomegalovirus enteritis and had no criteria for GI GVHD, the FC values were 15.4, 105, and 100.7. In a patient with Candida spp. infection FC was 13.9. The FC was higher in patients with grade IV GI GVHD, with median of 590 (r: 502–629). Conclusion: FC appears to be a promising non-invasive biomarker of acute GI GVHD. If these findings are confirmed, it may provide a useful non-invasive test for the diagnosis of GI GVHD in patients following allogeneic transplantation. Disclosures: No relevant conflicts of interest to declare.

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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 Transplantation ◽

10.1038/s41409-018-0381-4 ◽

2018 ◽

Vol 54 (7) ◽

pp. 1038-1048 ◽

Cited By ~ 3

Author(s):

Daniela Weber ◽

Markus Weber ◽

Katrin Hippe ◽

Sakhila Ghimire ◽

Daniel Wolff ◽

...

Keyword(s):

Graft Versus Host Disease ◽

Scoring System ◽

Contrast Enhanced Ultrasound ◽

Host Disease ◽

Graft Versus Host ◽

Non Invasive ◽

Contrast Enhanced ◽

New Scoring

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Non-invasive measurement techniques for quantitative assessment of optic nerve head blood flow

European Journal of Ophthalmology ◽

10.1177/1120672119858891 ◽

2019 ◽

Vol 30 (2) ◽

pp. 235-244 ◽

Cited By ~ 2

Author(s):

Fia Vosborg ◽

Lasse Malmqvist ◽

Steffen Hamann

Keyword(s):

Blood Flow ◽

Optic Nerve ◽

Optic Nerve Head ◽

Optical Coherence Tomography Angiography ◽

Laser Speckle ◽

Doppler Imaging ◽

Laser Speckle Flowgraphy ◽

Colour Doppler ◽

Non Invasive ◽

Colour Doppler Imaging

Diseases of the optic nerve head involving changes in blood flow are common. However, the pathophysiology is not always fully understood. Several non-invasive methods for measuring optic nerve head blood flow are available, but currently no gold standard has been established. Methods for measuring blood flow in optic neuropathies including colour Doppler imaging, retinal function imager, optical coherence tomography angiography and laser speckle flowgraphy are reviewed. Ultrasound colour Doppler imaging is a fast measurement technique where several different parameters, especially the blood flow velocity, can be calculated. Though used for many years in ophthalmology, its use is not standardized and it requires significant observer skills. The retinal function imager is a direct method where the haemoglobin in erythrocytes is visualized and blood flow velocities in retinal vessels are calculated from a series of photos. The technique is not suitable for direct measurement of blood flow within the optic nerve head. Laser speckle flowgraphy uses a laser light which creates a light scatter pattern in the tissue. Particles moving in the area causes changes in the speckle pattern from which a relative blood flow can be estimated. It is, however, not known whether optic nerve head microcirculation is measurable with the technique. Optical coherence tomography angiography uses multiple scans to evaluate blood flow with good reproducibility but often problems with artefacts. The technique is continuously being refined and increasingly used in research as a tool for the study of blood flow in retinopathies and optic neuropathies. Most of the conducted studies are based on small sample sizes, but some of the methods show promising results in an optic nerve head blood flow research setting. Further and larger studies are required to provide standardized and comparable measurements before one or more of the methods can be considered clinical helpful in daily practice.

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