MRI Findings of Immune Checkpoint Inhibitor-Induced Hypophysitis: Possible Association with Fibrosis
Hypophysitis is one of the well-known adverse effects of immune checkpoint inhibitors. Immune checkpoint inhibitor-induced hypophysitis frequently causes irreversible hypopituitarism, which requires long-term hormone replacement. Despite the high frequency and clinical significance, characteristic M...
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| Veröffentlicht in: | American journal of neuroradiology : AJNR 2020-09, Vol.41 (9), p.1683-1689 |
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| creator | Kurokawa, R Ota, Y Gonoi, W Hagiwara, A Kurokawa, M Mori, H Maeda, E Amemiya, S Usui, Y Sato, N Nakata, Y Moritani, T Abe, O |
| description | Hypophysitis is one of the well-known adverse effects of immune checkpoint inhibitors. Immune checkpoint inhibitor-induced hypophysitis frequently causes irreversible hypopituitarism, which requires long-term hormone replacement. Despite the high frequency and clinical significance, characteristic MR imaging findings of immune checkpoint inhibitor-induced hypophysitis have not been established. In the present study, we aimed to review and extract the MR imaging features of immune checkpoint inhibitor-induced hypophysitis.
This retrospective international multicenter study comprised 20 patients with melanoma who were being treated with immune checkpoint inhibitors and clinically diagnosed with immune checkpoint inhibitor-induced hypophysitis. Three radiologists evaluated the following MR imaging findings: enlargement of the pituitary gland and stalk; homogeneity of enhancement of the pituitary gland; presence/absence of a well-defined poorly enhanced area and, if present, its location, shape, and signal intensity in T2WI; and enhancement pattern in contrast-enhanced dynamic MR imaging. Clinical symptoms and hormone levels were also recorded.
Enlargement of the pituitary gland and stalk was observed in 12 and 20 patients, respectively. Nineteen patients showed poorly enhanced lesions (geographic hypoenhancing lesions) in the anterior lobe, and 11 of these lesions showed hypointensity on T2WI. Thyrotropin deficiency and corticotropin deficiency were observed in 19/20 and 12/17 patients, respectively, which persisted in 12/19 and 10/12 patients, respectively, throughout the study period.
Pituitary geographic hypoenhancing lesions in the anterior lobe of the pituitary gland are characteristic and frequent MR imaging findings of immune checkpoint inhibitor-induced hypophysitis. They reflect fibrosis and are useful in distinguishing immune checkpoint inhibitor-induced hypophysitis from other types of hypophysitis/tumors. |
| doi_str_mv | 10.3174/ajnr.A6692 |
| format | Article |
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This retrospective international multicenter study comprised 20 patients with melanoma who were being treated with immune checkpoint inhibitors and clinically diagnosed with immune checkpoint inhibitor-induced hypophysitis. Three radiologists evaluated the following MR imaging findings: enlargement of the pituitary gland and stalk; homogeneity of enhancement of the pituitary gland; presence/absence of a well-defined poorly enhanced area and, if present, its location, shape, and signal intensity in T2WI; and enhancement pattern in contrast-enhanced dynamic MR imaging. Clinical symptoms and hormone levels were also recorded.
Enlargement of the pituitary gland and stalk was observed in 12 and 20 patients, respectively. Nineteen patients showed poorly enhanced lesions (geographic hypoenhancing lesions) in the anterior lobe, and 11 of these lesions showed hypointensity on T2WI. Thyrotropin deficiency and corticotropin deficiency were observed in 19/20 and 12/17 patients, respectively, which persisted in 12/19 and 10/12 patients, respectively, throughout the study period.
Pituitary geographic hypoenhancing lesions in the anterior lobe of the pituitary gland are characteristic and frequent MR imaging findings of immune checkpoint inhibitor-induced hypophysitis. They reflect fibrosis and are useful in distinguishing immune checkpoint inhibitor-induced hypophysitis from other types of hypophysitis/tumors.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>DOI: 10.3174/ajnr.A6692</identifier><identifier>PMID: 32763900</identifier><language>eng</language><publisher>United States: American Society of Neuroradiology</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Fellows' Journal Club ; Female ; Fibrosis - chemically induced ; Fibrosis - diagnostic imaging ; Fibrosis - pathology ; Head & Neck ; Humans ; Hypophysitis - chemically induced ; Hypophysitis - diagnostic imaging ; Hypophysitis - pathology ; Immune Checkpoint Inhibitors - adverse effects ; Magnetic Resonance Imaging - methods ; Male ; Melanoma - drug therapy ; Melanoma, Cutaneous Malignant ; Middle Aged ; Retrospective Studies ; Skin Neoplasms - drug therapy</subject><ispartof>American journal of neuroradiology : AJNR, 2020-09, Vol.41 (9), p.1683-1689</ispartof><rights>2020 by American Journal of Neuroradiology.</rights><rights>2020 by American Journal of Neuroradiology 2020 American Journal of Neuroradiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c378t-a6ba7daf7f5eee0024baa63285dc43f1d7298b7de24cd372246203d6a39c89ab3</citedby><cites>FETCH-LOGICAL-c378t-a6ba7daf7f5eee0024baa63285dc43f1d7298b7de24cd372246203d6a39c89ab3</cites><orcidid>0000-0002-5018-4683 ; 0000-0003-1370-5272 ; 0000-0002-2132-1642 ; 0000-0003-2123-9187 ; 0000-0001-9537-1717 ; 0000-0001-7238-7951 ; 0000-0001-8992-2156 ; 0000-0002-3907-9188 ; 0000-0002-4909-8526 ; 0000-0002-1186-8900 ; 0000-0002-9305-7131 ; 0000-0002-1180-2629 ; 0000-0001-5277-3249</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583108/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7583108/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32763900$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kurokawa, R</creatorcontrib><creatorcontrib>Ota, Y</creatorcontrib><creatorcontrib>Gonoi, W</creatorcontrib><creatorcontrib>Hagiwara, A</creatorcontrib><creatorcontrib>Kurokawa, M</creatorcontrib><creatorcontrib>Mori, H</creatorcontrib><creatorcontrib>Maeda, E</creatorcontrib><creatorcontrib>Amemiya, S</creatorcontrib><creatorcontrib>Usui, Y</creatorcontrib><creatorcontrib>Sato, N</creatorcontrib><creatorcontrib>Nakata, Y</creatorcontrib><creatorcontrib>Moritani, T</creatorcontrib><creatorcontrib>Abe, O</creatorcontrib><title>MRI Findings of Immune Checkpoint Inhibitor-Induced Hypophysitis: Possible Association with Fibrosis</title><title>American journal of neuroradiology : AJNR</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>Hypophysitis is one of the well-known adverse effects of immune checkpoint inhibitors. Immune checkpoint inhibitor-induced hypophysitis frequently causes irreversible hypopituitarism, which requires long-term hormone replacement. Despite the high frequency and clinical significance, characteristic MR imaging findings of immune checkpoint inhibitor-induced hypophysitis have not been established. In the present study, we aimed to review and extract the MR imaging features of immune checkpoint inhibitor-induced hypophysitis.
This retrospective international multicenter study comprised 20 patients with melanoma who were being treated with immune checkpoint inhibitors and clinically diagnosed with immune checkpoint inhibitor-induced hypophysitis. Three radiologists evaluated the following MR imaging findings: enlargement of the pituitary gland and stalk; homogeneity of enhancement of the pituitary gland; presence/absence of a well-defined poorly enhanced area and, if present, its location, shape, and signal intensity in T2WI; and enhancement pattern in contrast-enhanced dynamic MR imaging. Clinical symptoms and hormone levels were also recorded.
Enlargement of the pituitary gland and stalk was observed in 12 and 20 patients, respectively. Nineteen patients showed poorly enhanced lesions (geographic hypoenhancing lesions) in the anterior lobe, and 11 of these lesions showed hypointensity on T2WI. Thyrotropin deficiency and corticotropin deficiency were observed in 19/20 and 12/17 patients, respectively, which persisted in 12/19 and 10/12 patients, respectively, throughout the study period.
Pituitary geographic hypoenhancing lesions in the anterior lobe of the pituitary gland are characteristic and frequent MR imaging findings of immune checkpoint inhibitor-induced hypophysitis. They reflect fibrosis and are useful in distinguishing immune checkpoint inhibitor-induced hypophysitis from other types of hypophysitis/tumors.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Fellows' Journal Club</subject><subject>Female</subject><subject>Fibrosis - chemically induced</subject><subject>Fibrosis - diagnostic imaging</subject><subject>Fibrosis - pathology</subject><subject>Head & Neck</subject><subject>Humans</subject><subject>Hypophysitis - chemically induced</subject><subject>Hypophysitis - diagnostic imaging</subject><subject>Hypophysitis - pathology</subject><subject>Immune Checkpoint Inhibitors - adverse effects</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Melanoma - drug therapy</subject><subject>Melanoma, Cutaneous Malignant</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Skin Neoplasms - drug therapy</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkF1LwzAUhoMobn7c-AMk10JnmrRJ44UwhnOFiSIK3oU0SdfMNSlNp-zf2zkdenUuzvs-5_AAcBGjEYlZci2Xrh2NKeX4AAxjTmjEU_52CIYo5mlEY5QNwEkIS4RQyhk-BgOCGSUcoSHQD885nFqnrVsE6EuY1_XaGTipjHpvvHUdzF1lC9v5NsqdXiuj4WzT-KbaBNvZcAOffAi2WBk4DsErKzvrHfy0XdVzi9YHG87AUSlXwZz_zFPwOr17mcyi-eN9PhnPI0VY1kWSFpJpWbIyNcYghJNCSkpwlmqVkDLWDPOsYNrgRGnCME4oRkRTSbjKuCzIKbjdcZt1URutjOtauRJNa2vZboSXVvzfOFuJhf8QLM1Ir6kHXO0Aqv87tKbcd2Mktq7F1rX4dt2HL_9e20d_5ZIvhll-MQ</recordid><startdate>20200901</startdate><enddate>20200901</enddate><creator>Kurokawa, R</creator><creator>Ota, Y</creator><creator>Gonoi, W</creator><creator>Hagiwara, A</creator><creator>Kurokawa, M</creator><creator>Mori, H</creator><creator>Maeda, E</creator><creator>Amemiya, S</creator><creator>Usui, Y</creator><creator>Sato, N</creator><creator>Nakata, Y</creator><creator>Moritani, T</creator><creator>Abe, O</creator><general>American Society of Neuroradiology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-5018-4683</orcidid><orcidid>https://orcid.org/0000-0003-1370-5272</orcidid><orcidid>https://orcid.org/0000-0002-2132-1642</orcidid><orcidid>https://orcid.org/0000-0003-2123-9187</orcidid><orcidid>https://orcid.org/0000-0001-9537-1717</orcidid><orcidid>https://orcid.org/0000-0001-7238-7951</orcidid><orcidid>https://orcid.org/0000-0001-8992-2156</orcidid><orcidid>https://orcid.org/0000-0002-3907-9188</orcidid><orcidid>https://orcid.org/0000-0002-4909-8526</orcidid><orcidid>https://orcid.org/0000-0002-1186-8900</orcidid><orcidid>https://orcid.org/0000-0002-9305-7131</orcidid><orcidid>https://orcid.org/0000-0002-1180-2629</orcidid><orcidid>https://orcid.org/0000-0001-5277-3249</orcidid></search><sort><creationdate>20200901</creationdate><title>MRI Findings of Immune Checkpoint Inhibitor-Induced Hypophysitis: Possible Association with Fibrosis</title><author>Kurokawa, R ; 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Immune checkpoint inhibitor-induced hypophysitis frequently causes irreversible hypopituitarism, which requires long-term hormone replacement. Despite the high frequency and clinical significance, characteristic MR imaging findings of immune checkpoint inhibitor-induced hypophysitis have not been established. In the present study, we aimed to review and extract the MR imaging features of immune checkpoint inhibitor-induced hypophysitis.
This retrospective international multicenter study comprised 20 patients with melanoma who were being treated with immune checkpoint inhibitors and clinically diagnosed with immune checkpoint inhibitor-induced hypophysitis. Three radiologists evaluated the following MR imaging findings: enlargement of the pituitary gland and stalk; homogeneity of enhancement of the pituitary gland; presence/absence of a well-defined poorly enhanced area and, if present, its location, shape, and signal intensity in T2WI; and enhancement pattern in contrast-enhanced dynamic MR imaging. Clinical symptoms and hormone levels were also recorded.
Enlargement of the pituitary gland and stalk was observed in 12 and 20 patients, respectively. Nineteen patients showed poorly enhanced lesions (geographic hypoenhancing lesions) in the anterior lobe, and 11 of these lesions showed hypointensity on T2WI. Thyrotropin deficiency and corticotropin deficiency were observed in 19/20 and 12/17 patients, respectively, which persisted in 12/19 and 10/12 patients, respectively, throughout the study period.
Pituitary geographic hypoenhancing lesions in the anterior lobe of the pituitary gland are characteristic and frequent MR imaging findings of immune checkpoint inhibitor-induced hypophysitis. They reflect fibrosis and are useful in distinguishing immune checkpoint inhibitor-induced hypophysitis from other types of hypophysitis/tumors.</abstract><cop>United States</cop><pub>American Society of Neuroradiology</pub><pmid>32763900</pmid><doi>10.3174/ajnr.A6692</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5018-4683</orcidid><orcidid>https://orcid.org/0000-0003-1370-5272</orcidid><orcidid>https://orcid.org/0000-0002-2132-1642</orcidid><orcidid>https://orcid.org/0000-0003-2123-9187</orcidid><orcidid>https://orcid.org/0000-0001-9537-1717</orcidid><orcidid>https://orcid.org/0000-0001-7238-7951</orcidid><orcidid>https://orcid.org/0000-0001-8992-2156</orcidid><orcidid>https://orcid.org/0000-0002-3907-9188</orcidid><orcidid>https://orcid.org/0000-0002-4909-8526</orcidid><orcidid>https://orcid.org/0000-0002-1186-8900</orcidid><orcidid>https://orcid.org/0000-0002-9305-7131</orcidid><orcidid>https://orcid.org/0000-0002-1180-2629</orcidid><orcidid>https://orcid.org/0000-0001-5277-3249</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Fellows' Journal Club Female Fibrosis - chemically induced Fibrosis - diagnostic imaging Fibrosis - pathology Head & Neck Humans Hypophysitis - chemically induced Hypophysitis - diagnostic imaging Hypophysitis - pathology Immune Checkpoint Inhibitors - adverse effects Magnetic Resonance Imaging - methods Male Melanoma - drug therapy Melanoma, Cutaneous Malignant Middle Aged Retrospective Studies Skin Neoplasms - drug therapy |
| title | MRI Findings of Immune Checkpoint Inhibitor-Induced Hypophysitis: Possible Association with Fibrosis |
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