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Research ArticleImaging

Immune Checkpoint Inhibitor–Related Adverse Effects and 18F-FDG PET/CT Findings

Jan-Henning Schierz, Ismet Sarikaya, Uwe Wollina, Leonore Unger and Ali Sarikaya
Journal of Nuclear Medicine Technology December 2021, 49 (4) 324-329; DOI: https://doi.org/10.2967/jnmt.121.262151
Jan-Henning Schierz
1Department of Radiology, Municipal Hospital Dresden, Dresden, Germany;
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Ismet Sarikaya
2Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Kuwait;
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Uwe Wollina
3Department of Dermatology, Municipal Hospital Dresden, Dresden, Germany;
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Leonore Unger
4Department of Rheumatology, Municipal Hospital Dresden, Dresden, Germany; and
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Ali Sarikaya
5Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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  • FIGURE 1.
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    FIGURE 1.

    Selected sagittal 18F-FDG PET/CT images of pelvis. Initial scan before treatment shows normal findings in colon (arrows, A), PET/CT scan 4 mo after nivolumab treatment shows colitis in sigmoid colon (arrows, B), and PET/CT scan 6 mo after discontinuation of nivolumab shows significant reduction in sigmoid activity (arrows, C).

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    FIGURE 2.

    Serial total-body 18F-FDG PET maximum-intensity projections of patient with history of melanoma after treatment with nivolumab (A), pembrolizumab (B), nivolumab (C), and steroids (D). Development, progression, and regression of arthritis are seen, as well as mild sarcoidlike uptake in chest and myositis.

  • FIGURE 3.
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    FIGURE 3.

    Sagittal total-body maximum-intensity-projection 18F-FDG PET images before (A) and after (B) nivolumab treatment. Increased uptake in lumbar spine is due to bursitis (arrows).

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    FIGURE 4.

    Total-body 18F-FDG PET maximum-intensity-projection images before (A) and after (B) nivolumab treatment in a melanoma case with multiple metastases. Increased bilateral uptake in hilar and mediastinal lymph nodes is due to sarcoidlike reaction (white arrows) and diffuse uptake in the stomach is due to gastritis (black arrow).

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    FIGURE 5.

    Selected transaxial and coronal contrast-enhanced CT images (A and C, before and 1 year after nivolumab treatment, respectively) and PET images (B, with start of nivolumab) in a case with history of melanoma. PET shows diffusely increased uptake in the thyroid due to thyroiditis (arrows), CT shows decrease in thyroid size 1 year after treatment as compared with pretreatment size (arrows pointing to the thyroid gland). Nodule in the right lower lobe is causing cold area on PET.

  • FIGURE 6.
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    FIGURE 6.

    Total-body 18F-FDG PET image after nivolumab treatment shows diffuse uptake in thyroid gland due to thyroiditis (arrows), mild diffuse uptake in liver due to hepatitis (arrow), and diffuse colonic uptake due to metformin use (arrows) in a case with history of melanoma.

  • FIGURE 7.
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    FIGURE 7.

    Selected transaxial and sagittal 18F-FDG PET images (A and B) and sagittal MR images (C and D, before and after treatment, respectively) show findings consistent with hypophysitis (arrows).

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Journal of Nuclear Medicine Technology: 49 (4)
Journal of Nuclear Medicine Technology
Vol. 49, Issue 4
December 1, 2021
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Immune Checkpoint Inhibitor–Related Adverse Effects and 18F-FDG PET/CT Findings
Jan-Henning Schierz, Ismet Sarikaya, Uwe Wollina, Leonore Unger, Ali Sarikaya
Journal of Nuclear Medicine Technology Dec 2021, 49 (4) 324-329; DOI: 10.2967/jnmt.121.262151

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Immune Checkpoint Inhibitor–Related Adverse Effects and 18F-FDG PET/CT Findings
Jan-Henning Schierz, Ismet Sarikaya, Uwe Wollina, Leonore Unger, Ali Sarikaya
Journal of Nuclear Medicine Technology Dec 2021, 49 (4) 324-329; DOI: 10.2967/jnmt.121.262151
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  • Article
    • Abstract
    • IMMUNE CHECKPOINT INHIBITORS
    • 18F-FDG PET/CT IMAGING
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Keywords

  • immune checkpoint inhibitor
  • 18F-FDG PET/CT
  • adverse effect
  • autoimmune
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