PDF(Pubmed)
Abstract：
Immunotherapy has revolutionized oncology care, improving patient outcomes in several cancers. However, these therapies are also associated with typical immune-related adverse events due to the enhanced inflammatory and immune response. These toxicities can arise at any time during treatment but are more frequent within the first few months. Any organ and tissue can be affected, ranging from mild to life-threatening. While some manifestations are common and more often mild, such as dermatitis and colitis, others are rarer and more severe, such as myocarditis. Management depends on the severity, with treatment being held for >grade 2 toxicities. Steroids are used in more severe cases, and immunosuppressive treatment may be considered for non-responsive toxicities, along with specific organ support. A multidisciplinary approach is mandatory for prompt identification and management. The diagnosis is primarily of exclusion. It often relies on imaging features, and, when possible, cytologic and/or pathological analyses are performed for confirmation. In case of clinical suspicion, imaging is required to assess the presence, extent, and features of abnormalities and to evoke and rule out differential diagnoses. This imaging-based review illustrates the diverse system-specific toxicities associated with immune checkpoint inhibitors and chimeric antigen receptor T-cells with a multidisciplinary perspective. Clinical characteristics, imaging features, cytological and histological patterns, as well as the management approach, are presented with insights into radiological tips to distinguish these toxicities from the most important differential diagnoses and mimickers-including tumor progression, pseudoprogression, inflammation, and infection-to guide imaging and clinical specialists in the pathway of diagnosing immune-related adverse events.
摘要：
免疫疗法彻底改变了肿瘤护理，改善几种癌症患者的预后。然而,这些治疗还与典型的免疫相关不良事件相关,这是由于炎症和免疫反应增强.这些毒性可以在治疗期间的任何时间出现，但在最初的几个月内更频繁。任何器官和组织都可能受到影响，从轻度到危及生命。虽然有些表现很常见，而且更常见的是温和的，如皮炎和结肠炎，其他人更罕见，更严重，比如心肌炎.管理取决于严重程度，治疗>2级毒性。类固醇用于更严重的病例，和免疫抑制治疗可以考虑无应答毒性，以及特定的器官支持。为了及时识别和管理，必须采用多学科方法。诊断主要是排除。它通常依赖于成像特征，and,如果可能,进行细胞学和/或病理学分析以确认。在临床怀疑的情况下，需要成像来评估存在，范围,和异常的特征，并唤起和排除鉴别诊断。这个基于成像的综述从多学科的角度说明了与免疫检查点抑制剂和嵌合抗原受体T细胞相关的多种系统特异性毒性。临床特征,成像特征,细胞学和组织学模式，以及管理方法，提供了对放射学技巧的见解，以区分这些毒性与最重要的鉴别诊断和模拟-包括肿瘤进展，伪进程，炎症,和感染-指导影像学和临床专家诊断免疫相关不良事件的途径。
