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Distinct Imaging Patterns of Immune Checkpoint Inhibitor-Induced Acute Pancreatitis

Publication ,  Journal Article
Kondo, J; Keraliya, A; Townsend, M; Giobbie-Hurder, A; Amirfazan, M; Grover, S
Published in: American Journal of Gastroenterology
October 25, 2022

Introduction: The presentation of immune checkpoint inhibitor (ICI)-induced pancreatic injury ranges from asymptomatic hyperlipasemia to acute pancreatitis. Imaging features of ICI-induced acute pancreatitis (ICI-AP) remain poorly described. We evaluated radiographic patterns of pancreatic inflammation in patients with ICI-AP. Methods: We assessed a retrospective cohort of patients diagnosed with ICI-AP after initiation of ICI therapy between 2011 and 2019. Abdominal imaging findings with computed tomography (CT), magnetic resonance imaging (MRI), and 18-Fluorine-flurodeoxyglucose positron emission tomography (18F-FDG PET/CT) were reviewed by an independent radiologist. We performed univariate analyses to evaluate associations between clinical characteristics and radiographic patterns of ICI-AP. Results: Among 6,450 cancer patients treated with ICI, 27 (0.4%) developed ICI-AP. All three Atlanta criteria for AP (typical symptoms, imaging, and lipase ≥3 upper limit of normal) were satisfied in 13 (48%). Abdominal pain was present in 23 (85%), and 4 (15%) presented asymptomatically with hyperlipasemia and pancreatic inflammation on imaging. Diagnostic abdominal imaging was performed in 26/27 patients (mean age 62.4 ± 11.3 years, 46% female, 92% White) via CT in 22 (85%), MRI in 3 (12%), and 18F-FDG PET/CT in 1 (4%). The most frequent radiologic appearance was a diffuse interstitial pattern with diffuse edematous pancreas and peripancreatic stranding, present in 10 (38%) patients, followed by a focal interstitial pattern with focal pancreatic edema and peripancreatic stranding in 7 (26%), and pancreatic enlargement without peripancreatic inflammation in 3 (12%). Six patients (23%) had normal imaging. Individuals with diffuse interstitial inflammation and normal imaging were more likely to be female (p=0.02). Those with diffuse inflammation or pancreatic enlargement without inflammation were older than those with focal inflammation and normal pancreatic imaging (p=0.046). Conclusion: We propose three distinct radiologic patterns of ICI-AP. The notable subset of patients who were asymptomatic but had imaging evidence of ICI-AP supports the role of abdominal imaging in patients on ICIs with hyperlipasemia. The presence of pancreatic enlargement without peripancreatic inflammation in a small but notable proportion of patients highlights the importance of comparing baseline pancreatic imaging when interpreting imaging for ICI-AP. (Table)

Duke Scholars

Published In

American Journal of Gastroenterology

DOI

ISSN

0002-9270

Publication Date

October 25, 2022

Volume

117

Issue

10S

Start / End Page

e47 / e48

Publisher

Lippincott, Williams & Wilkins

Related Subject Headings

  • Gastroenterology & Hepatology
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kondo, J., Keraliya, A., Townsend, M., Giobbie-Hurder, A., Amirfazan, M., & Grover, S. (2022). Distinct Imaging Patterns of Immune Checkpoint Inhibitor-Induced Acute Pancreatitis. American Journal of Gastroenterology, 117(10S), e47–e48. https://doi.org/10.14309/01.ajg.0000856900.02139.50
Kondo, Jordan, Abishek Keraliya, Matthew Townsend, Anita Giobbie-Hurder, Marta Amirfazan, and Shilpa Grover. “Distinct Imaging Patterns of Immune Checkpoint Inhibitor-Induced Acute Pancreatitis.” American Journal of Gastroenterology 117, no. 10S (October 25, 2022): e47–48. https://doi.org/10.14309/01.ajg.0000856900.02139.50.
Kondo J, Keraliya A, Townsend M, Giobbie-Hurder A, Amirfazan M, Grover S. Distinct Imaging Patterns of Immune Checkpoint Inhibitor-Induced Acute Pancreatitis. American Journal of Gastroenterology. 2022 Oct 25;117(10S):e47–8.
Kondo, Jordan, et al. “Distinct Imaging Patterns of Immune Checkpoint Inhibitor-Induced Acute Pancreatitis.” American Journal of Gastroenterology, vol. 117, no. 10S, Lippincott, Williams & Wilkins, Oct. 2022, pp. e47–48. Manual, doi:10.14309/01.ajg.0000856900.02139.50.
Kondo J, Keraliya A, Townsend M, Giobbie-Hurder A, Amirfazan M, Grover S. Distinct Imaging Patterns of Immune Checkpoint Inhibitor-Induced Acute Pancreatitis. American Journal of Gastroenterology. Lippincott, Williams & Wilkins; 2022 Oct 25;117(10S):e47–e48.
Journal cover image

Published In

American Journal of Gastroenterology

DOI

ISSN

0002-9270

Publication Date

October 25, 2022

Volume

117

Issue

10S

Start / End Page

e47 / e48

Publisher

Lippincott, Williams & Wilkins

Related Subject Headings

  • Gastroenterology & Hepatology
  • 1103 Clinical Sciences