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CT imaging findings of anti-PD-1 inhibitor-related enterocolitis.

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Abstract

Purpose

Immune checkpoint inhibitors promote the antitumor activity of T cells; however, there is a risk of side effects. The aim of this study was to characterize the computed tomography (CT) findings of one such side effect, anti-programmed cell death-1 antibody-related enterocolitis (αPD-1-EC).

Methods

This single-institution retrospective study included 21 patients with αPD-1-EC who underwent CT between January 2015 and April 2020. Two board-certified radiologists independently evaluated the CT findings, including the pattern of intestinal wall enhancement, maximum bowel wall thickness, maximum appendiceal diameter, and involvement of enterocolitis in each intestinal segment. Symptoms and their severity were also investigated.

Results

Pancolitis and skip lesions involving both the rectosigmoid colon and the cecum were found in 9 patients each (42.9%). The rectum was the most frequently involved lesion (18/21, 85.7%), and appendiceal involvement was found in 11 patients (52.4%). The most frequent wall enhancement pattern was the gray pattern (i.e., mild homogeneous enhancement of the thickened bowel wall). The mean maximum diameter of the involved appendix was 9.6 ± 4.5 mm (range 4.5–18 mm). Frequent symptoms included diarrhea (21/21), fever (8/21), and abdominal pain (7/21). Other concomitant immune-related adverse events were found in 6 patients.

Conclusions

Pancolitis, skip lesions, and appendiceal involvement were frequent in patients with αPD-1-EC. When combining these characteristic findings with other clinical findings, such as low-grade diarrhea, other concomitant immune-related adverse events, and anti-PD-1 therapy administration, CT may be a useful diagnostic tool for αPD-1-EC.

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Data availability

Data are available from the Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Institutional Data Access for researchers who meet the criteria for access to confidential data.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Mariko Kurokawa, Shinjiro Harayama & Yasunobu Takaki

  2. Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Ryo Kurokawa, Wataru Gonoi & Osamu Abe

  3. Department of Radiology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan

    Akifumi Hagiwara

  4. Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Koichi Koizumi

  5. Department of Dermato Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Koji Yoshino

  6. Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan

    Tsunekazu Hishima

  7. Department of Radiology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-0003, Japan

    Akira Baba

  8. Division of Neuroradiology, Department of Radiology, Michigan Medicine, 1500E Medical Center Drive, Ann Arbor, MI, 48109, USA

    Yoshiaki Ota

Authors
  1. Mariko Kurokawa
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  2. Ryo Kurokawa
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  8. Tsunekazu Hishima
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  12. Yasunobu Takaki
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Contributions

MK involved in conceptualization; MK, RK, AH, WG, YO, and AB participated in methodology; YT did validation ; MK and RK performed formal analysis and writing—original draft; MK, RK, and WG contributed to investigation ; KK, KY, and TH collected the resources ; MK and SH did data curation; RK, Ah, WG, YO, AB, and OAbe participated in writing—review & editing; and YT and OA involved in supervision.

Corresponding author

Correspondence to Ryo Kurokawa.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This single-institution retrospective study was approved by the local ethics committee and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.

Informed consent

The requirement for written informed consent was waived due to the retrospective design of the study. The privacy of all patients was protected in full.

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Kurokawa, M., Kurokawa, R., Hagiwara, A. et al. CT imaging findings of anti-PD-1 inhibitor-related enterocolitis.. Abdom Radiol 46, 3033–3043 (2021). https://doi.org/10.1007/s00261-021-02986-0

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