Michael Bazylewicz MD, Presenter: Nothing to Disclose

Christine Chan, Abstract Co-Author: Nothing to Disclose

Sandra J. Allison MD, Abstract Co-Author: Nothing to Disclose

Angela D. Levy MD, Abstract Co-Author: Nothing to Disclose

To determine if MDCT features of bowel wall thickening allows differentiation between normal bowel, ischemic bowel, rejection, post transplant lymphoproliferative disease (PTLD), and infection in patients with small bowel transplants.

CT scans (n=57) from isolated and multivisceral small bowel transplant patients (ages 1-62, mean 26) were retrospectively reviewed with consensus reading by two radiologists blinded to pathology results. Patients had endoscopic biopsy within 3 days of CT scanning. Small bowel was assessed for wall thickening, attenuation and enhancement pattern, feces sign, pneumatosis, dilatation, mesenteric edema and adenopathy, ascites, anasarca, vascular patency, and whether the scan was done with oral or IV contrast. Demographic data obtained: age, gender, race, and transplant type. Kappa power analysis determined a goal of 20 patients per group would show at least a 60% correlation exists between groups. For the continuous variable, the differences in the averages were tested and the non-parametric Kruskal Wallis test was used since normality assumptions were not satisfied. Chi-square and Fisher’s exact tests were used to investigate the differences for categorical variables. A p-value of <.05 is considered a significant difference.

No statistical differences in age (0.69 pediatric, 0.2 adult), race (0.6), or transplant type (0.56). Significant difference between the normal and ischemia subgroup was observed in gender (0.04). No difference was observed in wall thickening (0.29), attenuation (0.66), bowel enhancement pattern (0.66), feces sign (0.1), pneumatosis (0.67), dilatation (0.11), mesenteric edema (0.8), mesenteric adenopathy (0.5), anasarca (0.89), vascular patency (0.5), those with oral contrast enhanced scans (0.23), or those with IV contrast enhanced scans (0.59). A general difference between the 5 categories was noted in the category of ascites (0.03), however specific analysis of normal vs. the four abnormal subgroups demonstrated no significant difference (ischemia 0.28, rejection 0.052, infection 0.55, PTLD 0.39).

There is no correlation between small bowel wall thickening in patients with small bowel transplant and the common complications including ischemia, rejection, PTLD, and infection.

Small bowel wall thickening on MDCT in small bowel transplants is likely non-contributory in determining an underlying pathologic condition.

Bazylewicz, M, Chan, C, Allison, S, Levy, A, Small Bowel Transplantation: MDCT Features of Wall Thickening with Pathologic Correlation.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13017687.html