Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Abdom Radiol (NY). 2021 Jul;46(7):3033-3043. doi: 10.1007/s00261-021-02986-0. Epub 2021 Feb 26.
Immune checkpoint inhibitors promote the antitumor activity of T cells; however, there is a risk of side effects. The aim of this study was to characterize the computed tomography (CT) findings of one such side effect, anti-programmed cell death-1 antibody-related enterocolitis (αPD-1-EC).
This single-institution retrospective study included 21 patients with αPD-1-EC who underwent CT between January 2015 and April 2020. Two board-certified radiologists independently evaluated the CT findings, including the pattern of intestinal wall enhancement, maximum bowel wall thickness, maximum appendiceal diameter, and involvement of enterocolitis in each intestinal segment. Symptoms and their severity were also investigated.
Pancolitis and skip lesions involving both the rectosigmoid colon and the cecum were found in 9 patients each (42.9%). The rectum was the most frequently involved lesion (18/21, 85.7%), and appendiceal involvement was found in 11 patients (52.4%). The most frequent wall enhancement pattern was the gray pattern (i.e., mild homogeneous enhancement of the thickened bowel wall). The mean maximum diameter of the involved appendix was 9.6 ± 4.5 mm (range 4.5-18 mm). Frequent symptoms included diarrhea (21/21), fever (8/21), and abdominal pain (7/21). Other concomitant immune-related adverse events were found in 6 patients.
Pancolitis, skip lesions, and appendiceal involvement were frequent in patients with αPD-1-EC. When combining these characteristic findings with other clinical findings, such as low-grade diarrhea, other concomitant immune-related adverse events, and anti-PD-1 therapy administration, CT may be a useful diagnostic tool for αPD-1-EC.
免疫检查点抑制剂可增强 T 细胞的抗肿瘤活性，但存在发生副作用的风险。本研究旨在描述免疫检查点抑制剂相关的一种副作用——抗程序性死亡受体-1 抗体相关结肠炎（αPD-1-EC）的 CT 表现。
本单中心回顾性研究纳入了 21 例经 CT 检查的 αPD-1-EC 患者，检查时间为 2015 年 1 月至 2020 年 4 月。2 名经过委员会认证的放射科医生独立评估 CT 结果，包括肠壁强化模式、最大肠壁厚度、最大阑尾直径以及每个肠段受累情况。还调查了症状及其严重程度。
9 例患者（42.9%）存在全结肠炎和累及直肠乙状结肠及盲肠的节段性病变，18 例患者（85.7%）直肠受累最常见，11 例患者（52.4%）阑尾受累。最常见的肠壁强化模式为灰色模式（即增厚肠壁的轻度均匀强化）。受累阑尾的平均最大直径为 9.6±4.5mm（范围 4.5-18mm）。常见症状包括腹泻（21/21）、发热（8/21）和腹痛（7/21）。6 例患者存在其他合并免疫相关不良事件。
αPD-1-EC 患者常出现全结肠炎、节段性病变和阑尾受累。当将这些特征性表现与其他临床发现（如低级别腹泻、其他合并免疫相关不良事件以及抗 PD-1 治疗）相结合时，CT 可能成为诊断 αPD-1-EC 的一种有用工具。
