Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Eur J Radiol. 2020 Oct;131:109250. doi: 10.1016/j.ejrad.2020.109250. Epub 2020 Aug 29.
To describe contrast-enhanced computed tomography (CECT), 18-Fluorine (F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and magnetic resonance imaging (MRI) findings of immune checkpoint inhibitor (ICI) associated pancreatitis in patients undergoing immunotherapy for solid malignant tumours.
In this retrospective study, 25 patients with clinical and/or biochemical evidence of pancreatitis who underwent CECT, MRI and F-FDG-PET/CT while being treated with ICIs were included. Imaging features of acute pancreatitis included: pancreatic enlargement, heterogeneous enhancement, peripancreatic stranding, fluid collection, pseudocyst, necrosis, atrophy and calcification. F-FDG PET/CT imaging was reviewed for pattern of abnormally increased pancreatic FDG uptake. ICI-associated pancreatitis diagnosis was based on clinical, imaging and biochemical findings.
Imaging findings of ICI-associated pancreatitis included diffuse (n = 14) or focal (n = 11) pancreatic enlargement; heterogenous enhancement (n = 21); focal (n = 9) or diffuse (n = 15) peripancreatic infiltration on CECT and MRI. A pattern consistent with acute interstitial pancreatitis was present in 20/25 (80 %) patients, and a pattern consistent with autoimmune pancreatitis in 4/25 (16 %). A mixed pattern was present in one patient (4%). No patient developed necrotizing pancreatitis or a pseudocyst. The CT severity index was < 3 in all patients, consistent with mild pancreatitis. Focal pancreatic FDG uptake was noted in 2/3 (66 %) of patients. Acute imaging findings resolved with treatment in all 25 patients. Pancreatic atrophy developed in 11/25 (44 %).
ICI-associated pancreatitis typically presents as either focal or diffuse acute interstitial pancreatitis. Post-pancreatitis atrophy is common. The ICI-associated pancreatitis cases in our study were mild, managed conservatively and did not result in local acute complications.
描述接受免疫治疗的实体恶性肿瘤患者中，免疫检查点抑制剂（ICI）相关胰腺炎的增强计算机断层扫描（CECT）、氟-18-氟代脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT 和磁共振成像（MRI）表现。
在这项回顾性研究中，纳入了 25 例有临床和/或生化胰腺炎证据且正在接受 ICI 治疗的患者，这些患者接受了 CECT、MRI 和 F-FDG-PET/CT 检查。急性胰腺炎的影像学特征包括：胰腺增大、不均匀强化、胰周渗出、积液、假性囊肿、坏死、萎缩和钙化。对 F-FDG PET/CT 成像进行回顾，以观察胰腺 FDG 摄取异常增加的模式。根据临床、影像学和生化表现诊断 ICI 相关胰腺炎。
ICI 相关胰腺炎的影像学表现包括弥漫性（n=14）或局灶性（n=11）胰腺增大；不均匀强化（n=21）；CECT 和 MRI 上可见局灶性（n=9）或弥漫性（n=15）胰周浸润。25 例患者中有 20 例（80%）存在符合急性间质性胰腺炎的表现，4 例（16%）存在符合自身免疫性胰腺炎的表现，1 例（4%）存在混合表现。没有患者发生坏死性胰腺炎或假性囊肿。所有患者的 CT 严重指数均<3，提示为轻度胰腺炎。25 例患者中有 2 例（66%）出现局灶性胰腺 FDG 摄取。所有 25 例患者的急性影像学表现均在治疗后得到缓解。25 例患者中有 11 例（44%）发生胰腺萎缩。
ICI 相关胰腺炎通常表现为局灶性或弥漫性急性间质性胰腺炎。胰腺炎后萎缩很常见。我们研究中的 ICI 相关胰腺炎病例为轻度，经保守治疗，未导致局部急性并发症。
