Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Bologna, Italy.
Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, via Albertoni 15, Bologna, Italy.
Eur J Radiol. 2021 May;138:109617. doi: 10.1016/j.ejrad.2021.109617. Epub 2021 Feb 25.
Cancer treatments with immune checkpoint inhibitors (ICI) are associated with a unique set of drug toxicities called immune-related adverse events (irAES). The aim of the present study was to describe the radiological manifestation of irAES detectable by CT.
Retrospective analysis of 284 patients treated with ICI for various types of advanced cancer; of them, 129 patients were selected, all having been treated with single-agent ICI, and all with a baseline CT scan and follow-up scans available at our Institute. CT examinations were reviewed by two radiologists involved in the study with a consensus reading. Imaging findings consistent with irAES were reported and correlated with clinical-laboratory data.
Immune-related adverse events were found in 25/129 (19.4 %) patients. No statistically significant differences were found in either the prevalence of irAES or in the time of onset of tumour type. Thoracic complications were detected in 14/25 (56.0 %) patients consisting in: 3 radiation recall pneumonia, 3 Transient Asymptomatic Pulmonary Opacities (TAPOs), 3 hypersensitivity pneumonia, 2 diffuse alveolar damage, 2 organizing pneumonia, 1 sarcoid-like reaction. In the remaining 11/25 (44.0 %), there were extra-pulmonary complications: 3 colitis, 4 cholecystitis, 2 pancreatitis and 2 cases of visceral ischemia.
Radiologists should be aware of the wide spectrum of irAES as they could affect the outcome. Pneumonia is the most frequent irAES; however, the international classification for interstitial lung disease does not seem to be capable of describing all possible drug-related pulmonary toxicities. Additional findings included TAPOs, radiation recall pneumonia and sarcoid-like reaction.
免疫检查点抑制剂（ICI）的癌症治疗与一组称为免疫相关不良事件（irAES）的独特药物毒性相关。本研究的目的是描述 CT 可检测到的 irAES 的放射学表现。
回顾性分析了 284 例接受 ICI 治疗的各种晚期癌症患者；其中，选择了 129 例患者，所有患者均接受单药 ICI 治疗，且在我院均有基线 CT 扫描和随访扫描。由两名参与研究的放射科医生进行 CT 检查审查，采用共识阅读。报告与 irAES 一致的影像学发现，并与临床-实验室数据相关联。
在 129 例患者中，发现了 25 例（19.4%）免疫相关不良事件。irAES 的患病率或肿瘤类型的发病时间均无统计学差异。在 25 例患者中检测到胸部并发症（14/25，56.0%），包括：3 例放射性肺炎、3 例一过性无症状性肺混浊（TAPOs）、3 例过敏肺炎、2 例弥漫性肺泡损伤、2 例机化性肺炎、1 例类肉瘤样反应。在其余 11 例（44.0%）患者中，存在肺外并发症：3 例结肠炎、4 例胆囊炎、2 例胰腺炎和 2 例内脏缺血。
放射科医生应意识到 irAES 的广泛谱，因为它们可能会影响结果。肺炎是最常见的 irAES；然而，国际间质性肺病分类似乎无法描述所有可能与药物相关的肺部毒性。其他发现包括 TAPOs、放射性肺炎和类肉瘤样反应。
