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In recent years, immunotherapies comprehending Chimeric Antigen Receptor T-cell (CAR T) therapy and immune checkpoint inhibitors (ICIs) have become part of the therapeutic arsenal to fight cancer, significantly improving patient outcomes. However, they are hindered by toxicities arising from an exaggerated inflammatory response secondary to immune system activation. In this context, different types of neurotoxicities have been described, namely immune effector cell-associated neurotoxicity syndrome (ICANS) in CAR T-cell therapy recipients and immune-related adverse events (ir-AEs) in patients undergoing ICIs administration. Early recognition and monitoring of these complications are essential for timely intervention with the aim of resolving neurological deficits and concomitantly pursue good oncological outcome. Neuroimaging plays a significant role in the diagnostic work-up, helping to differentiate immunotherapy-related neurotoxicity from other neurologic complications such as infection, metastases, and paraneoplastic syndromes. By highlighting characteristic neuroimaging findings across modalities including MRI, CT, and PET, this chapter aims to support clinicians and radiologists in recognizing and managing neurotoxicity in the era of immunotherapy.

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Neuroradiological Findings in Neurological Adverse Events of CAR T therapy

  • 章节

  • 发表日期：

    2026年

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  • Federica Pondrelli,
  • Simone Rossi,
  • Gian Maria Asioli,
  • Luca Spinardi,
  • Maria Guarino

摘要

In recent years, immunotherapies comprehending Chimeric Antigen Receptor T-cell (CAR T) therapy and immune checkpoint inhibitors (ICIs) have become part of the therapeutic arsenal to fight cancer, significantly improving patient outcomes. However, they are hindered by toxicities arising from an exaggerated inflammatory response secondary to immune system activation. In this context, different types of neurotoxicities have been described, namely immune effector cell-associated neurotoxicity syndrome (ICANS) in CAR T-cell therapy recipients and immune-related adverse events (ir-AEs) in patients undergoing ICIs administration. Early recognition and monitoring of these complications are essential for timely intervention with the aim of resolving neurological deficits and concomitantly pursue good oncological outcome. Neuroimaging plays a significant role in the diagnostic work-up, helping to differentiate immunotherapy-related neurotoxicity from other neurologic complications such as infection, metastases, and paraneoplastic syndromes. By highlighting characteristic neuroimaging findings across modalities including MRI, CT, and PET, this chapter aims to support clinicians and radiologists in recognizing and managing neurotoxicity in the era of immunotherapy.