Diagnosis of Graft-vs-Host disease after bone marrow transplantation by in Vivo Proton MR Spectroscopy of the liver: correlation with pathologic results

초록

Objective: To know the differences of the proton MR spectroscopic features of the liver between the patients with graft-versus-host disese(GVHD) and without GVHD after BMT. and to evaluate the possibility to discriminate GVHD fro non-GVHD by analysis of the in vivo proton MR sepctra. Patients and method: We evaluated the in vivo proton MR spectra from the livers of 37 patients who underwent BMT. Our series included 14 cases with GVHD and 23 without GVHD in the liver. Nineteen men and 18 women were included in our series. All cases of GVHD and non-GVHD were confirmed by liver biopsy and remaining of non-GVHD by evaluation clinical follow up. Proton MR spectroscopy was performed at 1.5T GE Sign Horizon system using localized proton STEAM sequence and body coil in all cases with subjects were located in supine position. No respiratory interruption was required during the spectroscopic signal acquisition. Parameter using in MRS were: TR=over 300ms, TE=30ms, number of scans=128, voxel size=(2X2X2)cm3, and one NEX. We evaluated the spectra with an attention to the differences of perrerns of the peaks between GVHD and non-GVHD groups. The ration of peak area of peaks at 1.6-4.1ppm to lipid was calculated in GVHD and non-GVHD group, and compared the results between these groups. We evaluated the sensitivity and specificity for discriminating GVHD from non-GVHD by anal of H-MRS. Results: The proton MR spectra of the liver with GVHD showed significantly increased amount of t metabolites at 1.6-4.1ppm as compared with that of non-GVHD. The ratio of P/P in GVHD hroup was much higher than that of non-GVHD group with a statistical significance(p<0.005) due to increased area of the peaks at 1.6-4.1ppm. Mean2.19+2.07 and 0.29+0.13, respectively. With a cut-off value of 0.42 for discriminating GVHD from non-GVHD, the sensitivity was 85.7%(12/14) and the specificity was 82.6%(19/23). Result: GVHD can be distinguished from non-GVHD by analysis of in vivo proton MR spectroscopy feat