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Checkpoint Inhibitor Immune-Related Adverse Events: A Multimodality Pictorial Review

Published:April 02, 2022DOI:https://doi.org/10.1016/j.acra.2022.03.007
      Cancer immunotherapies are drugs that modulate the body's own immune system as an anticancer strategy. Checkpoint inhibitor immunotherapies interfere with cell surface binding proteins that function to promote self-recognition and tolerance, ultimately leading to upregulation of the immune response. Given the striking success of these agents in early trials in melanoma and lung cancer, they have now been studied in many types of cancer and have become a pillar of anticancer therapy for many tumor types. However, abundant upregulation results in a new class of side effects, known as immune-related adverse events (IRAEs). It is critical for the practicing radiologist to be able to recognize these events to best contribute to care for patients on checkpoint inhibitor immunotherapy. Here, we provide a comprehensive system-based review of immune-related adverse events and associated imaging findings. Further, we detail the best imaging modalities for each as well as describe problem solving modalities. Given that IRAEs can be subclinical before becoming clinically apparent, radiologists may be the first provider to recognize them, providing an opportunity for early treatment. Awareness of IRAEs and how to best image them will prepare radiologists to make a meaningful contribution to patient care as part of the clinical team.

      Key Words

      Abbreviations:

      CTLA-4 (cytotoxic T-lymphocyte–associated antigen 4), PD-1 (programmed cell death protein 1), NSCLC (non-small cell lung cancer), IRAE (immune-related adverse event), RT (radiotherapy), CTCAE (Common Terminology Criteria for Adverse Events), CT (computed tomography), HRCT (high resolution computed tomography), PET/CT (positron emission tomography/computed tomography), MRI (magnetic resonance imaging), RT (radiation therapy), ASCO (American Society of Clinical Oncology), OP (organizing pneumonia), NSIP (nonspecific interstitial pneumonia), HP (hypersensitivity pneumonitis), DCMi (inflammatory dilated cardiomyopathy), FSE (fast spin echo), STIR (short-tau inversion recovery), AST (aspartate aminotransferase), ALT (alanine transaminase), HIDA (hepatobiliary iminodiacetic acid), AKI (acute kidney injury), CNS (central nervous system), FLAIR (fluid attenuated inversion recovery), EEG (electroencephalogram), CSF (cerebrospinal fluid), IVIG (intravenous immunoglobulin), TSH (thyroid stimulating hormone), NSAIDS (non-steroidal anti-inflammatory drugs), PMR (polymyalgia rheumatica), GCA (giant cell arteritis)
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