CT features of primary colorectal signet-ring cell carcinoma

PURPOSE: The purpose of this work was to evaluate the CT features of 15 patients with primary colorectal signet-ring cell carcinomas. METHOD: We retrospectively reviewed the CT scans of 15 patients (mean age 44 years) with pathologically proved colorectal signet-ring cell carcinoma. On CT, we evaluated the site and length of the tumor, bowel wall thickening patterns, perirectal or pericolic infiltration, the presence or absence of colonic obstruction, and metastasis to other organs. RESULTS: The tumors were located in the rectum in nine patients, the sigmoid colon in one, the hepatic flexure in one, the transverse colon in one, the ascending colon in two, and the cecum in one. The tumor length ranged from 4.0 to 10.0 cm (mean 6.1 cm) with mean thickness of 2.1 cm. CT showed concentric bowel wall thickening in all patients ("even" in 8 and "uneven" in 7), target appearance was noted in 4, perirectal or pericolic infiltrations were moderate to severe in 12, and colorectal obstruction was seen in 6. In the tumor spread patterns, lymphadenopathy was noted in 13, invasion to adjacent pelvic organs in 5, peritoneal carcinomatosis in 4, liver metastasis in 2, and periureteric metastasis in 1. CONCLUSION: Primary signet-ring cell colorectal carcinoma should be included for differential consideration when CT shows a long length of concentric bowel wall thickening and target sign, especially when such findings occur in the rectum and in young patients.     

CT findings in peripheral T-cell lymphoma involving the gastrointestinal tract

PURPOSE: To evaluate whether computed tomography (CT) accurately depicted gastrointestinal tract involvement in peripheral T-cell lymphoma (PTCL). MATERIALS AND METHODS: CT scans were retrospectively reviewed in 14 patients with pathologically proved PTCLs of the gastrointestinal tract for the following considerations: sites, patterns of involvement (ie, morphologic features, bowel wall thickness or mass size, and contrast enhancement pattern), and ancillary findings at other sites (ie, lymphadenopathy, bowel perforation, and involvement of other organs). RESULTS: PTCL involved the stomach in three patients, the small intestine in eight, both the stomach and the small intestine in one, and the sigmoid colon in two; multifocal involvement was seen in three (21%) patients. CT failed to demonstrate the bowel lesions in three of 14 patients. At CT, 11 patients had gastric or bowel wall thickening (n = 10) and a polypoid mass (n = 1). In 10 patients, the gastric or bowel wall thickening was mild (<1 cm) in six, moderate (1-2 cm) in three, and severe (>2 cm) in one. Lymphadenopathy was noted in nine (64%) patients, with the nonbulky type in eight and the bulky type in one. Bowel perforation occurred in four (29%) patients. Other organs were involved in eight (57%) patients. CONCLUSION: CT can depict PTCL involving the gastrointestinal tract if it is not confined to the mucosa. There is a tendency toward preferential jejunal or duodenal involvement, as well as bowel perforation.     

输卵管卵巢脓肿的CT诊断价值

目的 总结分析女性输卵管卵巢脓肿的CT特征，以寻求和探讨鉴别诊断依据及CT诊断的价值。方法 回顾性分析10例输卵管卵巢脓肿患者CT腹盆腔增强扫描资料。结果 10例患者CT均显示附件区厚壁囊性或囊实混合性肿块，肿块外缘模糊毛糙，增强多见脓肿壁呈厚壁分层强化及内部强化分隔。其他伴随的CT表现：子宫骶骨韧带增厚9例，直肠周围、骶前脂肪密度增高模糊9例，显示输卵管扩张积脓或积液的管状结构影6例，宫腔积液4例。CT观察到脓肿与盆腔结构粘连包括：肿块与子宫粘连者9例，与直肠、乙状结肠粘连者4例，与盆腔小肠肠管及盆壁结构广泛粘连3例；显示腹膜增厚伴腹水及右侧输卵管卵巢脓肿伴阑尾炎各2例。结论 CT除了能观察附件区囊实性肿块，还能显示相邻盆腔器官的受累粘连及盆底软组织或筋膜层的炎性浸润，能对附件脓肿做定性和定位诊断，对诊断不清的可疑妇科感染有鉴别价值。     

Primary malignant melanoma of the rectum: CT findings in eight patients

PURPOSE: To retrospectively evaluate computed tomographic (CT) findings in patients with pathologically proved primary malignant melanoma of the rectum. MATERIALS AND METHODS: CT scans of eight patients (three men and five women; age range, 38-74 years; mean age, 62 years) with histologically proved primary rectal malignant melanomas were retrospectively evaluated by two radiologists in consensus. Scans were evaluated for the involved site, approximate size and morphologic appearance of the primary mass, degree of perirectal infiltration, and presence or absence of lymphadenopathy, bowel obstruction, and distant metastases. RESULTS: All of the tumors were located in the distal rectum just above the anal verge. The approximate average sizes of the tumors were as follows: length, 4.8 cm (range, 3.8-6.9 cm); width, 3.8 cm (range, 2.8-5.2 cm); and mean diameter, 4.3 cm (range, 3.3-5.8 cm). Tumors usually appeared as polypoid or fungating intraluminal masses (n = 7). Perirectal infiltration commonly extended to the pelvic side wall or the presacral space (n = 5). All eight patients had lymphadenopathy, frequently larger than 3 cm in diameter (n = 3), which most commonly involved the perirectal lymph node station (n = 7). There was no evidence of bowel obstruction in any of the patients. Distant metastasis involving the liver was noted in one patient. CONCLUSION: On CT scans, primary rectal malignant melanomas appeared as bulky intraluminal fungating masses in the distal rectum, focally expanding and obscuring the lumen without causing obstruction, with perirectal infiltration and frequently enlarged lymph nodes.     

Granulocytic sarcoma of bowel: CT findings

PURPOSE: To evaluate retrospectively the computed tomographic (CT) findings of granulocytic sarcoma of the bowel. MATERIALS AND METHODS: The institutional review boards of all participating institutions approved this study and waived the requirement for informed consent. CT scans were retrospectively reviewed in eight patients (seven men, one woman; age range, 23-71 years; mean age, 46 years) with pathologically proved granulocytic sarcoma of the small and/or large bowel. CT findings were evaluated with regard to the sites, morphologic characteristics, and contrast material enhancement patterns of the lesions, along with other ancillary findings (ie, peritoneal and mesenteric infiltration, ascites, lymphadenopathy, bowel perforation, and obstruction). RESULTS: Eight patients had a total of 13 lesions in the bowel (of which eight were pathologically proved), involving the duodenum (n=1), jejunum (n=2), ileum (n=5), sigmoid colon (n=1), and rectum (n=4); multifocal bowel lesions were noted in four patients. The lesion varied in shape, with wall thickening alone in three of 13 lesions, an intraluminal polypoid mass in four, an exophytic mass in one, and a combination of findings in five. Contrast material enhancement, relative to the back musculature, showed isoattenuation in seven lesions, hyperattenuation in four, and hypoattenuation in two. Five of eight patients had multiple peritoneal masses with diffuse mesenteric or peritoneal infiltration. Ascites was present in six of eight patients; lymphadenopathy (especially in the mesentery), in five; bowel perforation, in two; and bowel obstruction, in one. CONCLUSION: Granulocytic sarcoma of the bowel is characterized by variability in shape and contrast enhancement and has a high predilection for mesenteric and peritoneal spread.     

Magnetic resonance imaging of actinomycosis presenting as pelvic malignancy

Pelvic actinomycosis is associated with long-standing use of an intrauterine contraceptive device and may present with clinical signs and symptoms of pelvic malignancy. Diagnostic imaging can confirm the presence of a pelvic mass and tissue infiltration but findings are often non-specific. We present a case of pelvic actinomycosis with tubo-ovarian abscess in which magnetic resonance imaging demonstrated lower signal intensity tissue on T2 weighted sequences than would be typical for pelvic malignancy or infection and was useful in confirming regression of pelvic disease in response to antibiotic therapy.     

Peritoneal leiomyosarcomatosis originating from gastrointestinal leiomyosarcomas: CT features

PURPOSE: To evaluate the computed tomographic (CT) features of peritoneal leiomyosarcomatosis (PL) originating from gastrointestinal leiomyosarcoma and compare the CT features of primary gastrointestinal leiomyosarcomas between patients with and those without PL. MATERIALS AND METHODS: The authors reviewed the medical and surgical-pathology records and the CT scans of 89 patients with gastrointestinal leiomyosarcoma to determine the prevalence of PL. Also, the CT scans of the patients with PL were evaluated for the morphologic appearance of peritoneal lesions. The CT features of the primary tumors were compared between the patients with and those without PL. Student t and Fisher exact tests were performed. RESULTS: Metastases were present in 39 patients. PL was seen in 25 patients. Other metastatic sites included liver in 26 patients, lymph nodes in 11, lungs in three, and bone in one. In the 25 patients with PL, CT findings included multiple discrete peritoneal nodules in 22 patients and massive peritoneal lesions in three. Smudged omental infiltration was combined with other findings in 10 patients. The sites of the peritoneal masses were mesentery in 18 patients, omentum in 11, paracolic gutters in 11, pelvic cavity in eight, perihepatic space in three, and perisplenic space in one. Four patients had ascites. There were statistically significant differences in size of primary tumor (mean diameter, 12.5 cm vs 9.2 cm) (P =.01) and prevalence of exophytic growth of primary tumor (P =.02) between the patients with and those without PL. CONCLUSION: CT findings can indicate PL in the differential diagnosis. The prevalence of PL appears to be higher when it originates from large primary tumors.     

胃肠道穿孔的螺旋CT诊断价值

目的探讨螺旋CT在胃肠道损伤诊断中的作用。方法对28例经手术证实胃肠道损伤患者的CT资料进行回顾分析。结果CT发现腹腔游离气体24例,肠壁增厚9例,腹腔积液20例,系膜密度增高5例,反射性肠郁张3例。结论腹腔游离气体是诊断胃肠道穿孔最强有力的指征,而腹腔积液、肠壁增厚和系膜密度增高等征象高度提示胃肠道穿孔。     

Correlation of incidental colorectal wall thickening at CT compared to colonoscopy

Incidental colon wall thickening is a common finding on computed tomography (CT) scans obtained in patients presenting to the emergency department. Currently, there are no guidelines for the emergency department physician or primary care physician regarding the need for further evaluation, specifically colonoscopy, in these patients. A retrospective review of 2,850 abdominopelvic CT scans performed from April 2006 to September 2006 was conducted. Three hundred twenty-two patients had incidental colon wall thickening and 150 of these patients had a subsequent colonoscopy. This study focused on those 150 patients and analyzed the correlation between the CT scan findings of wall thickening of the colon and the findings on colonoscopy. The CT scan findings correlated with abnormal colonoscopic findings in 96 out of 150 (64%) of our cases. In a specific subgroup, 12 out of 12 (100%) of these CT scans were also noted to have a mass lesion, as well as colon wall thickening, all of which were consistent with an adenoma or carcinoma found on colonoscopy. Incidental colorectal wall thickening at CT scan is due to nonspecific colitis in majority of the cases. Admission to the hospital should be based upon criteria other than this incidental radiological finding. However, patients with colorectal wall thickening with a mass lesion at CT scan should be followed closely as inpatient or outpatient given the high correlation with significant findings on colonoscopy.     

Small bowel rupture after blunt trauma: Computed tomographic signs and their sensitivity

The purpose of this study is to describe the characteristic computed tomographic (CT) signs of small bowel perforation after blunt abdominal trauma and to evaluate their sensitivity. Nineteen preoperative CT scans were obtained from 16 patients with surgically proven small bowel rupture secondary to blunt abdominal trauma. Only the CT findings described in the original CT reports were used. Eleven of 19 CT scans (58 %) had findings that were unequivocal for bowel rupture (i.e., extraluminal air and/or extravasation of oral contrast medium). Seven CT scans (37 %) had findings that were suggestive of severe small bowel injury (i.e., focal small bowel wall thickening and/or free peritoneal fluid without other accompanying organ injuries). In all, 95 % of cases of small bowel rupture had either pathognomonic or suggestive CT findings. One CT scan did not demonstrate small bowel wall thickening, although a hemoperitoneum was present. CT is a sensitive method for suggesting severe small bowel injury and rupture secondary to blunt abdominal trauma.     

CT of blunt trauma bowel and mesenteric injury: typical findings and pitfalls in diagnosis.

Detection of bowel and mesenteric injury can be challenging in patients after blunt abdominal trauma. Early diagnosis and treatment are critical to decrease patient morbidity and mortality. Computed tomography (CT) has become the primary modality for the imaging of these patients. Signs of bowel perforation such as free air and contrast material are virtually pathognomonic. Bowel-wall thickening, free fluid, and mesenteric infiltration may be seen with this type of injury and partial thickness injuries. The authors present and discuss the range of CT findings seen with bowel and mesenteric injuries. Examples of observation and interpretation errors are also provided to highlight pitfalls encountered in the evaluation of abdominopelvic CT scans in patients after blunt trauma.     

Computed tomographic features of appendiceal serositis in pelvic inflammatory disease: comparison with pathological findings

OBJECTIVE: The purpose of this study was to describe the computed tomographic (CT) features of the appendiceal serositis in women with pelvic inflammatory disease and to compare these with the pathological findings. METHODS: Appendiceal serositis was pathologically evaluated in patients with pelvic inflammatory disease who underwent surgery within 3 days of computed tomography. On retrospective review of CT findings, each appendix was evaluated for the following characteristics: location relative to the cecum, maximal diameter, morphology of wall thickening, contrast enhancement, and presence of appendicolith and cecal wall thickening. The presence of fatty infiltration of the periappendiceal fat, mesentery, and omentum was evaluated. The presence of pelvic abscess or ascites, lymph nodes, and paralytic ileus was noted. RESULTS: On pathological review, 10 patients were shown to have appendiceal serositis: mild serositis in 3 patients, moderate in 4, and severe in 3. The maximal appendiceal diameter ranged from 5.4 to 8.9 mm (mean diameter, 7.1 +/- 0.9 mm). Diffuse wall thickening with collapsed lumen was detected in 6 patients. Focal wall thickening with intraluminal gas bubbles or an air-fluid level was detected in 4 cases. Peripheral rim enhancement of the appendix was detected in 3 patients with focal wall-thickened appendix. There was no association between the feature of appendiceal wall thickening and the pathological severity of serositis. Mesenteric fatty infiltration was detected in 5 patients and omental fatty infiltration in 3 patients. Fatty infiltration of the mesentery and omentum was more commonly presented in patients with severe serositis. Pelvic abscesses, including pyosalpinx, were detected in 7 patients; a small amount of free fluid was seen in 8 patients. CONCLUSIONS: The CT findings of appendiceal serositis are diffuse or focal wall thickening without severe distension, common association with mesenteric fatty infiltration, and pelvic abscesses.     

Computed tomographic features of peritoneal carcinomatosis treated by intraperitoneal chemohyperthermia

PURPOSE: The purpose of this work was to describe the computed tomography (CT) features of peritoneal carcinomatosis after surgery combined with intraperitoneal chemohyperthermia (IPCH). METHOD: Between 1999 and 2001, 51 consecutive patients (33 women and 18 men, with a mean age 45 years) were treated in our institution with IPCH for peritoneal carcinomatosis. Patients that were symptomatic (33 patients) underwent contrast enhanced helical CT of the abdomen and the pelvis during the first 15 postoperative days. The CT scans were reviewed retrospectively by two blinded observers. Computed tomography abnormalities were compared with surgical, biochemical, and clinical findings. RESULTS: None of the CT scans were completely normal. Most postsurgical CT findings, including bowel and peritoneal thickening (14 and 13 cases, respectively), increased intraperitoneal fat density (13 cases), and compartmentalized ascites (8 cases), resulted from an inflammatory mesenteric reaction or inflammation of the small bowel or the peritoneum and did not require specific treatment. Major complications requiring appropriate treatment were intra-abdominal abscesses (5 cases), hemoperitoneum (5 cases), urinary fistula (2 cases), acute pancreatitis (1 case) and abdominal wall abscesses (2 cases). CONCLUSION: Knowledge of early CT findings after therapy with surgery combined with IPCH for peritoneal carcinomatosis is useful for accurate posttreatment management of these patients.     

Vascular contact with soft tissue: a sign of mesenteric masses at computed tomography

PURPOSE: To evaluate prevalence of mesenteric vascular contact at routine computed tomography (CT) and evaluate its value for distinguishing missed mesenteric masses from adjacent bowel. MATERIALS AND METHODS: We identified 18 abdominopelvic CT scans of 9 patients in whom mesenteric masses were missed on the prospective CT reports. We recorded the long-axis diameter of the masses, time interval to eventual detection, and presence of vascular contact (fat plane obscuration) with a mesenteric vessel greater than 1 mm in diameter. We also retrospectively identified 129 consecutive abdominopelvic CT scans of nononcology patients and recorded all locations of vascular contact between a mesenteric vessel greater than 1 mm in diameter and adjacent bowel. RESULTS: In the 18 CT examinations where mesenteric masses were missed, the mean long-axis diameter was 2.9 cm, and time between the initial CT scan and first discovery was 12 months. Mesenteric vessels contacted the masses in 17 (94%) of 18 scans. In the 129 nononcology patients, vascular contact was rarely seen with bowel distal to the proximal jejunum (6 had vascular contact with distal jejunum, 5 with ileum, and 0 with colon). However, the third and fourth duodenal portions showed vascular contact with the superior mesenteric vessels in 36 (28%) and 12 patients (9.4%), respectively, and with the inferior mesenteric vessels in 58 patients (48%). CONCLUSIONS: At CT, mesenteric vessels greater than 1 mm in diameter rarely contact bowel other than the duodenum and proximal jejunum; however, they often contact mesenteric masses. At CT scan review, inspection of the mesenteric vessels may facilitate mesenteric mass identification.     

螺旋CT在胃肠道穿孔中的诊断价值

目的:评价胃肠道穿孔的螺旋CT诊断价值。方法:33例经手术证实的胃肠道穿孔患者中,术前行腹部平片检查者28例,腹部CT扫描者33例。回顾性分析其CT表现,比较两种检查方法的诊断结果。结果:本组中X线平片和CT显示腹内游离气体的阳性率分别为71.4%(20/28例)和90.9%(30/33例),差异有显著性意义(P<0.05)。CT显示腹内游离气体呈新月状或小气泡影(n=30),胃肠穿孔处周围局限性积液或蜂窝组织炎(n=21),阑尾周围脓肿(n=4),肠梗阻(n=8),胃肠壁增厚(n=16),胃肠壁肿块(n=2),少量腹水(n=5)。术前CT对胃肠道穿孔病因诊断的符合率为87.9%(29/33)。结论:螺旋CT对诊断胃肠道穿孔及其病因和并发症有明显优势。     

螺旋CT在消化道穿孔中的诊断价值

目的：分析CT在消化道穿孔中的诊断价值。方法回顾性分析51例经手术证实的消化道穿孔病例,术前行立位腹部平片检查者41例,腹部CT扫描者51例,比较两种检查方法在消化道穿孔中的诊断价值。结果41例X线片检出游离气体26例,CT检出50例,CT检出率高于普通X线检查（P＜0．05）。CT显示腹内游离气体呈新月状或小气泡影（50例）,胃肠穿孔处周围局限性积液或蜂窝织炎（34例）,阑尾周围脓肿（3例）,肠梗阻（5例）,胃肠壁增厚（25例）,胃肠壁肿块（2例）,胃肠壁缺损（4例）,腹水（30例）。CT对穿孔病因的诊断符合率为68．6％（35/51）,对穿孔部位的诊断符合率为88．2％（45/51）。结论螺旋CT诊断胃肠道穿孔是一种有效的检查方法,且对穿孔部位和病因的诊断也具有重要价值。     

Analysis of mesenteric thickening on computed tomography

Computed Tomography (CT) provides a noninvasive information in the evaluation of abnormalities of the gastrointestinal tract by direct imaging of the bowel wall and adjacent mesentery. Several prior studies have discussed the variable CT appearances of mesenteric abnormalities, such as lymphoma, metastasis, inflammatory disease and edema. Although mesenteric thickening was mentioned in these studies, no study has provided a detailed analysis of the CT appearance of the thickened mesentery. Two characteristic types of mesenteric thickening were identified in 47 patients. Type I is "Intra-mesenteric thickening", which was noted in 25 patients with vascular obstruction, inflammatory disease and edema. Type II is "Mesenteric surface thickening", which was noted in 22 patients with peritonitis carcinomatosa, peritoneal mesothelioma, tuberculous peritonitis and pseudomyxoma peritoneal. An understanding of these two types of mesenteric disease is important in the identification of mesenteric pathology.     

Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT

OBJECTIVE: We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS: We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS: Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION: Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.     

Bowel wall thickening in patients with Crohn's disease: CT patterns and correlation with inflammatory activity

AIM: To assess CT patterns of bowel wall thickening in patients with Crohn's disease and to correlate these patterns with inflammatory activity. MATERIALS AND METHODS: We conducted a retrospective review of 58 helical abdominal CT scans of 53 patients with pathologically proven Crohn's disease. CT patterns of thickened bowel wall were divided into four types based on patterns of mural stratification and enhancement: type A, multilayered mural stratification; type B, two layers with strong mucosal enhancement and prominent low-density submucosa; type C, two layers without strong mucosal enhancement; and type D, homogeneous enhancement. We evaluated CT findings of the bowel and adjacent structures. We also reviewed pathologic features and clinical data to determine inflammatory activity. RESULTS: Fifty-five (95%) of 58 CT examinations showed bowel wall thickening. Of these 55 CT scans, type A pattern was found in 33 (60%), type B in 10 (18%), type C in five (9%), and type D in seven (13%). CT scans with type A showed significantly more wall thickening than those with either type C or type D. Histology revealed 43 cases with active disease and 12 with quiescent appearance. Thirty of 33 CT scans with type A and all 10 with type B were classified as acute disease, and three of five with type C and six of seven with type D as quiescent. CONCLUSION: In patients with Crohn's disease, CT patterns of bowel wall thickening correlated with inflammatory activity. Thickened bowel wall with layering enhancement is predictive of acute disease, and that of homogeneous enhancement suggests quiescence.     

CT features with pathologic correlation of acute gastrointestinal graft-versus-host disease after bone marrow transplantation in adults

OBJECTIVE: This study was conducted to describe the CT features of acute gastrointestinal graft-versus-host disease in adults and to correlate these findings with the pathologic grades of disease severity. MATERIALS AND METHODS: Patients (n = 22) with a history of allogeneic bone marrow transplantation and pathologically confirmed acute gastrointestinal graft-versus-host disease underwent contrast-enhanced (n = 13) and unenhanced (n = 9) CT. CT scans were retrospectively evaluated for intestinal and extraintestinal abnormalities by two radiologists who were unaware of the biopsy results. The CT findings were correlated with the pathologic grade of disease severity using the Pearson's correlation coefficient and the two-tailed nonparametric Spearman's rank correlation coefficient. RESULTS: CT features included small-bowel wall thickening (22/22), engorgement of the vasa recta adjacent to affected bowel segments (20/22), stranding of the mesenteric fat (16/22), large-bowel wall thickening (13/22), bowel dilatation proximal to thickened wall segments (5/22), ascites (10/22), periportal edema (8/22), mucosal enhancement (7/13), and serosal enhancement (4/13). The wall thickening had a discontinuous distribution in nine patients (41%). Bowel wall thickening was associated with high-grade graft-versus-host disease in patients in whom the distal esophagus (p = 0.015), ileum (p = 0.034), or ascending colon (p = 0.05) was involved. Increasing numbers of thickened bowel segments correlated with high-grade graft-versus-host disease (r = 0.548, p = 0.008). Increasing numbers of abnormal CT findings did not correlate with high-grade graft-versus-host disease (r = 0.117, p = 0.604). CONCLUSION: A variety of bowel abnormalities can be seen on CT in patients with acute graft-versus-host disease. CT findings associated with high-grade graft-versus-host disease are thickening of the distal esophagus, ileum, or ascending colon, as well as increasing numbers of thickened bowel wall segments.