Zhang Qian, Tao Xiuli, Zhao Shijun, Li Ning, Wang Shuhang, Wu Ning
Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Nuclear Medicine (PET-CT Center), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Diagnostics (Basel). 2023 Feb 12;13(4):691. doi: 10.3390/diagnostics13040691.
To investigate the predictive ability of clinical and chest computed tomography (CT) features to predict the severity of symptomatic immune checkpoint inhibitor-related pneumonitis (CIP).
This study included 34 patients diagnosed with symptomatic CIP (grades 2-5) and divided into mild (grade 2) and severe CIP (grades 3-5) groups. The groups' clinical and chest CT features were analyzed. Three manual scores (extent, image finding, and clinical symptom scores) were conducted to evaluate the diagnostic performance alone and in combination.
There were 20 cases of mild CIP and 14 cases of severe CIP. More severe CIP occurred within 3 months than after 3 months (11 vs. 3 cases, = 0.038). Severe CIP was significantly associated with fever ( < 0.001) and the acute interstitial pneumonia/acute respiratory distress syndrome pattern ( = 0.001). The diagnostic performance of chest CT scores (extent score and image finding score) was better than that of clinical symptom score. The combination of the three scores demonstrated the best diagnostic value, with an area under the receiver operating characteristic curve of 0.948.
The clinical and chest CT features have important application value in assessing the disease severity of symptomatic CIP. We recommend the routine use of chest CT in a comprehensive clinical evaluation.
探讨临床及胸部计算机断层扫描（CT）特征对有症状的免疫检查点抑制剂相关肺炎（CIP）严重程度的预测能力。
本研究纳入34例诊断为有症状CIP（2 - 5级）的患者，并分为轻度（2级）和重度CIP（3 - 5级）组。分析两组的临床及胸部CT特征。进行三项人工评分（范围、影像表现和临床症状评分）以单独及联合评估诊断性能。
有20例轻度CIP和14例重度CIP。重度CIP在3个月内发生的比3个月后更多（11例对3例，P = 0.038）。重度CIP与发热（P < 0.001）及急性间质性肺炎/急性呼吸窘迫综合征模式（P = 0.001）显著相关。胸部CT评分（范围评分和影像表现评分）的诊断性能优于临床症状评分。三项评分联合显示出最佳诊断价值，受试者操作特征曲线下面积为0.948。
临床及胸部CT特征在评估有症状CIP的疾病严重程度方面具有重要应用价值。我们建议在全面临床评估中常规使用胸部CT。
