Pan Xiaohuan, Xie Xiaohong, Chen Xiaojuan, Chen Huai
From the Department of Radiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China.
J Comput Assist Tomogr. 2024;48(6):930-935. doi: 10.1097/RCT.0000000000001643. Epub 2024 Aug 12.
Lung cancer has the highest morbidity and mortality in the world, and immunotherapies have been developed for this disease in recent years. However, activation of the immune system can cause immune-related adverse events (irAEs), and checkpoint inhibitor-related pneumonitis (CIP), can be the most severe and fatal. But few reports have systematically examined the spectrum of imaging findings of this condition. Therefore, the objective of this paper is to investigate the high-resolution computed tomography (HRCT) characteristics of CIP in patients with lung cancer.
To investigate the HRCT characteristics of CIP in patients with lung cancer.
HRCT patterns in 41 lung cancer patients who developed CIP after treatment with immune checkpoint inhibitors were retrospectively characterized by interstitial lung disease classification, and their severity was graded. Specific HRCT characteristics related to CIP were identified.
There are 4 types of immunotherapy-induce pneumonitis patterns (organizing pneumonia OP 19 cases, nonspecific interstitial pneumonia NSIP 8 cases, acute interstitial pneumonia AIP 7 cases, 7 cases of undetermined type) and image grade (13 cases of grade 1, 17 cases of grade 2, 11 cases of grade 3, 0 cases of grade 4) were identified. Spatial distribution characteristics of these lesions were noted (17 cases predominantly distributed in tumor-containing lobes, 6 cases predominantly distributed in non-tumor-containing lobes, and no specific predilection in 18 cases). Specific CT imaging features found in CIP included, in the order of prevalence, the following: ground glass opacities (38 cases), subpleural/vertical line (37 cases), interstitial thickening around the bronchovascular bundles (36 cases), reticulation (34 cases), fine reticular shadow (31 cases), consolidation (31 cases), small cystic shadow (24 cases, may not having honeycombing), small nodules (17 cases), bronchiectasis (15 cases), honeycombing (11 cases), mosaic sign (11 cases), and pleural effusion (18 cases).
HRCT of CIP predominantly manifests as ground glass opacities, reticulation, subpleural/vertical line, interstitial thickening around the bronchovascular bundle, and consolidation.
肺癌在全球发病率和死亡率最高，近年来针对该疾病研发了免疫疗法。然而，免疫系统的激活可导致免疫相关不良事件（irAEs），而检查点抑制剂相关肺炎（CIP）可能最为严重且致命。但很少有报告系统地研究这种情况的影像学表现谱。因此，本文的目的是探讨肺癌患者中CIP的高分辨率计算机断层扫描（HRCT）特征。
探讨肺癌患者中CIP的HRCT特征。
对41例接受免疫检查点抑制剂治疗后发生CIP的肺癌患者的HRCT图像，按照间质性肺疾病分类进行回顾性特征分析，并对其严重程度进行分级。确定与CIP相关的特定HRCT特征。
确定了4种免疫治疗诱导的肺炎模式（机化性肺炎OP 19例、非特异性间质性肺炎NSIP 8例、急性间质性肺炎AIP 7例、未定型7例）以及图像分级（1级13例、2级17例、3级11例、4级0例）。记录了这些病变的空间分布特征（17例主要分布在含肿瘤肺叶，6例主要分布在不含肿瘤肺叶，18例无特定偏好）。CIP中发现的特定CT影像学特征按出现频率依次为：磨玻璃影（38例）、胸膜下/垂直线（37例）、支气管血管束周围间质增厚（36例）、网状影（34例）、细网状阴影（31例）、实变（31例）、小囊状影（24例，可能无蜂窝状改变）、小结节（17例）、支气管扩张（15例）、蜂窝状改变（11例）、马赛克征（11例）、胸腔积液（18例）。
CIP的HRCT主要表现为磨玻璃影、网状影、胸膜下/垂直线、支气管血管束周围间质增厚及实变。
