Neuroimaging Findings of CAR T-Cell-Associated Neurotoxicity: A Review

Chimeric antigen receptor T-cell (CAR-T) therapy has remarkable efficacy in treating refractory hematologic malignancies. However, CAR-T therapy may induce neurotoxic effects in some patients. Common symptoms of neurotoxicity range from early signs such as headache, confusion, delirium, and aphasia to severe manifestations such as seizures, motor weakness, increased intracranial pressure, cerebral edema, and coma. Magnetic resonance imaging (MRI) can offer invaluable insight into resulting abnormalities in the structure, physiology, and function of the central nervous system. This review aims to examine the current literature on brain MRI findings of CAR-T-induced neurotoxicity, elucidating its diagnostic capabilities, clinical implications, and emerging trends in advancing imaging modalities. An improved understanding of neural correlates of CAR-T neurotoxicity is important for early detection, development of neuroprotective strategies, and optimization of CAR-T regimens to maximize therapeutic efficacy while minimizing adverse neurotoxic effects.