Journal Article (Review Article)

DZNE-2026-00068

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Bildgebung neurologischer Nebenwirkungen unter Immuntherapien : Immuncheckpoint-Inhibitoren und CAR-T-Zellen | Imaging of neurological adverse events associated with immunotherapies : Immune checkpoint inhibitors and CAR-T cells

Neumann, T. J. ; Baz, A. M. ; Schmidt, E. N. C. ; Bendella, Z.DZNE* ; Clauberg, R. ; Radbruch, A.DZNE* ; Pröbstel, A.-K.Extern* ; Bischof, A.Extern* ; Möhn, N. ; Wichtmann, B. D. (Last author)DZNE*

2026
Springer Medizin Verlag GmbH [Berlin]

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Please use a persistent id in citations: doi:10.1007/s00117-025-01541-y

Abstract: Immune checkpoint inhibitors (ICI) and chimeric antigen receptor T‑cell (CAR-T) therapies have fundamentally transformed oncology. With their increasing use, immune-related adverse events (irAEs) have gained attention, including those affecting the nervous system.To describe the clinical and imaging characteristics of neurological immune-related adverse events (NirAEs) under ICI and CAR‑T therapy, as well as their differential diagnostic and therapeutic implications.Review of current literature on the incidence, clinical spectrum, and imaging features of NirAEs.NirAEs occur in approximately 1-6% of patients treated with ICIs. Common manifestations include myositis, myasthenic syndromes, peripheral neuropathies, and various forms of encephalitis, which may differ clinically and radiologically from their idiopathic or paraneoplastic counterparts. Under CAR‑T therapy, immune effector cell-associated neurotoxicity syndrome (ICANS) represents the most frequent neurotoxic complication and affects about 30% of patients. Magnetic resonance imaging (MRI) is the imaging modality of choice but often reveals nonspecific or initially unremarkable findings. A pretherapeutic baseline MRI and close imaging follow-up improve diagnostic interpretation and prognostic assessment. Findings must always be interpreted within the clinical context and through interdisciplinary collaboration.NirAEs are rare but potentially life-threatening. Due to unspecific imaging findings and overlapping differential diagnoses, close interdisciplinary cooperation between radiology, neurology, and oncology is essential. Early recognition and imaging follow-up are key to improving prognosis and survival.

Keyword(s): Humans (MeSH) ; Immune Checkpoint Inhibitors: adverse effects (MeSH) ; Immune Checkpoint Inhibitors: therapeutic use (MeSH) ; Immunotherapy, Adoptive: adverse effects (MeSH) ; Magnetic Resonance Imaging: methods (MeSH) ; Neurotoxicity Syndromes: diagnostic imaging (MeSH) ; Neurotoxicity Syndromes: etiology (MeSH) ; Immunotherapy: adverse effects (MeSH) ; Nervous System Diseases: diagnostic imaging (MeSH) ; Nervous System Diseases: chemically induced (MeSH) ; Diagnosis, Differential (MeSH) ; Receptors, Chimeric Antigen (MeSH) ; Central and peripheral nervous system ; ICANS (immune effector cell–associated neurotoxicity syndrome) ; Magnetic resonance imaging ; Neuroradiological diagnostics ; Neurotoxicity under immunotherapy ; Immune Checkpoint Inhibitors ; Receptors, Chimeric Antigen

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Contributing Institute(s):

1. Clinical Neuroimaging (AG Radbruch)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

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Database coverage:
; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; DEAL Springer ; DEAL Springer ; Essential Science Indicators ; IF < 5 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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