Imaging findings of immune checkpoint inhibitor associated pancreatitis Journal Article
| Authors: | Das, J. P.; Postow, M. A.; Friedman, C. F.; Do, R. K.; Halpenny, D. F. |
| Article Title: | Imaging findings of immune checkpoint inhibitor associated pancreatitis |
| Abstract: | Purpose: To describe contrast-enhanced computed tomography (CECT), 18-Fluorine (18F)-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and magnetic resonance imaging (MRI) findings of immune checkpoint inhibitor (ICI) associated pancreatitis in patients undergoing immunotherapy for solid malignant tumours. Method: In this retrospective study, 25 patients with clinical and/or biochemical evidence of pancreatitis who underwent CECT, MRI and 18F-FDG-PET/CT while being treated with ICIs were included. Imaging features of acute pancreatitis included: pancreatic enlargement, heterogeneous enhancement, peripancreatic stranding, fluid collection, pseudocyst, necrosis, atrophy and calcification. 18F-FDG PET/CT imaging was reviewed for pattern of abnormally increased pancreatic FDG uptake. ICI-associated pancreatitis diagnosis was based on clinical, imaging and biochemical findings. Results: Imaging findings of ICI-associated pancreatitis included diffuse (n = 14) or focal (n = 11) pancreatic enlargement; heterogenous enhancement (n = 21); focal (n = 9) or diffuse (n = 15) peripancreatic infiltration on CECT and MRI. A pattern consistent with acute interstitial pancreatitis was present in 20/25 (80 %) patients, and a pattern consistent with autoimmune pancreatitis in 4/25 (16 %). A mixed pattern was present in one patient (4%). No patient developed necrotizing pancreatitis or a pseudocyst. The CT severity index was < 3 in all patients, consistent with mild pancreatitis. Focal pancreatic FDG uptake was noted in 2/3 (66 %) of patients. Acute imaging findings resolved with treatment in all 25 patients. Pancreatic atrophy developed in 11/25 (44 %). Conclusions: ICI-associated pancreatitis typically presents as either focal or diffuse acute interstitial pancreatitis. Post-pancreatitis atrophy is common. The ICI-associated pancreatitis cases in our study were mild, managed conservatively and did not result in local acute complications. © 2020 Elsevier B.V. |
| Keywords: | adult; major clinical study; clinical feature; drug withdrawal; nuclear magnetic resonance imaging; computer assisted tomography; image analysis; risk factor; risk assessment; disease severity; immunotherapy; contrast enhancement; pancreatitis; fluorodeoxyglucose f 18; iohexol; methylprednisolone; drug toxicity; fluorine 18; pancreas disease; pancreas pseudocyst; autoimmune pancreatitis; infliximab; acute pancreatitis; mycophenolic acid; oncologic imaging; nivolumab; cancer; human; male; female; priority journal; article; pembrolizumab; immunostimulating agent; positron emission tomography-computed tomography; pancreas calcification; pancreas necrosis; pancreatic enlargement |
| Journal Title: | European Journal of Radiology |
| Volume: | 131 |
| ISSN: | 0720-048X |
| Publisher: | Elsevier B.V |
| Date Published: | 2020-10-01 |
| Start Page: | 109250 |
| Language: | English |
| DOI: | 10.1016/j.ejrad.2020.109250 |
| PROVIDER: | scopus |
| PUBMED: | 32905952 |
| PMCID: | PMC8522849 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 October 2020 -- Source: Scopus |
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