Figure 4.

MRI of immune-related adverse events associated with immune checkpoint blockade. (A) T2 FLAIR imaging showed the simultaneous reduction of melanoma brain metastases and development of new diffuse inflammatory lesions (bright signal indicated by red arrow) in the brain, brain stem, and cerebellum of a patient who developed encephalomyelitis following two cycles of combined ipilimumab (ipi) and nivolumab (nivo). The inflammatory lesion in the brain was shown to resolve over time following temporary cessation of ICI treatment and 10 days of high-dose steroids. (B) T₁-weighted imaging revealed multiple marginal bony erosions (pink arrow) and synovial enhancement following intravenous gadolinium-based contrast administration at the metacarpophalangeal, proximal interphalangeal, and intercarpal joints (blue arrows), and tenosynovitis (pink arrows), in both hands of a patient with ICI-associated inflammatory arthritis. (C) Increased T1 and T2 relaxation times associated with myocardial inflammation and late gadolinium enhanced lesions (white arrow) indicating myocardial necrosis and fibrosis as a latent effect of ICI-associated myocarditis. Images reproduced with permission from Bjursten et al, Subedi et al, and Faron et al 142 147 148. FLAIR, fluid-attenuated inversion recovery; ICI, immune checkpoint inhibitors.