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Background  Graft versus host disease (GvHD) is a frequent complication of allogeneic stem cell transplantation (alloSCT), significantly increasing mortality. Previous imaging studies focused on the assessment of intestinal GvHD with contrast-enhanced MRI/CT or  18 F-FDG-PET imaging alone. The objective of this retrospective study was to elucidate the diagnostic value of a combined  18 F-FDG-PET-MRI protocol in patients with acute intestinal GvHD.    Methods  Between 2/2015 and 8/2019, 21 patients with acute intestinal GvHD underwent  18 F-FDG-PET-MRI. PET, MRI and PET-MRI datasets were independently reviewed. Readers assessed the number of affected segments of the lower gastrointestinal tract and the reliability of the diagnosis on a 5-point Likert scale and quantitative PET (SUVmax, SUVpeak, metabolic volume (MV)) and MRI parameter (wall thickness), were correlated to clinical staging of acute intestinal GvHD.    Results  The detection rate for acute intestinal GvHD was 56.8% for PET, 61.4% for MRI and 100% for PET-MRI. PET-MRI (median Likert-scale value: 5; range: 4–5) offers a significantly higher reliability of the diagnosis compared to PET (median: 4; range: 2–5;  p  = 0.01) and MRI alone (median: 4; range: 3–5;  p  = 0.03). The number of affected segments in PET-MRI (r s  = 0.677;  p  <  0.001) and the MV (r s  = 0.703;  p <   0.001) correlated significantly with the clinical stage. SUVmax (r s  = 0.345;  p  = 0.14), SUVpeak (r s  = 0.276;  p  = 0.24) and wall thickening (r s  = 0.174;  p  = 0.17) did not show a significant correlation to clinical stage.    Conclusion   18 F-FDG-PET-MRI allows for highly reliable assessment of acute intestinal GvHD and adds information indicating clinical severity.

18F-FDG-PET-MRI for the assessment of acute intestinal graft-versus-host-disease (GvHD)