Expected and non-expected immune-related adverse events detectable by CT

Area of Science:

• Radiology
• Oncology
• Pulmonology

Background:

• Immune checkpoint inhibitors (ICI) are crucial cancer therapies.
• ICI treatment is associated with immune-related adverse events (irAES).
• Radiological manifestations of irAES require characterization.

Purpose of the Study:

• To describe the computed tomography (CT) imaging findings of irAES.
• To correlate radiological findings with clinical data.

Main Methods:

• Retrospective analysis of 129 patients treated with single-agent ICI.
• Review of CT scans by two radiologists with consensus reading.
• Correlation of imaging findings with clinical-laboratory data.

Main Results:

• 19.4% of patients (25/129) experienced irAES.
• Thoracic complications occurred in 56% of affected patients, including various pneumonias and opacities.
• Extra-pulmonary complications included colitis, cholecystitis, pancreatitis, and visceral ischemia.

Conclusions:

• Radiologists must recognize the diverse CT spectrum of irAES.
• Pneumonia is the most frequent irAES, but current classifications may not capture all drug-related lung toxicities.
• Transient Asymptomatic Pulmonary Opacities (TAPOs), radiation recall pneumonia, and sarcoid-like reactions are notable findings.