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Multi-detector computed tomography (MDCT)–based severity score as a prognostic tool in patients with suspected immune checkpoint inhibitor therapy associated colitis



This study aimed to assess MDCT as a diagnostic and prognostic tool in patients with suspected immune checkpoint inhibitor (ICI)-related colitis.

Materials and methods

This retrospective cohort study included patients receiving ICIs at three hospitals between 2015 and 2019 who underwent both abdominopelvic MDCT and endoscopic biopsy to workup suspected ICI-related colitis. Two radiologists independently reviewed MDCT images for signs of colitis based on pre-defined features. Diagnostic performance of MDCT was calculated and categorical variables between treatment subgroups were compared. Logistic regression was used to develop proposed MDCT criteria for diagnosis and MDCT severity score based on a combination of MDCT features of colitis to predict the patient outcomes in ICI-related colitis.


A total of 118 MDCT scans from 108 patients were evaluated for suspected colitis, with 72 confirmed ICI-related colitis cases. Sensitivity, specificity, PPV, and NPV of MDCT for diagnosis of ICI-related colitis was 81% (58/72), 52 % (24/46), 73% (58/80), and 63% (24/38), respectively. Small bowel involvement was visualized in 25% of cases with ICI-related colitis (18/72). In melanoma patients presenting with diarrhea grade ≥ 2 (= 40), MDCT had the best diagnostic performance for ICI-related colitis (specificity = 80% [8/10], PPV = 92% [23/25]). MDCT severity scores predicted intravenous steroid use (OR 10.3, p = 0.004), length of stay > 7 days (OR 9.0, p < 0.001), and endoscopic mucosal ulceration (OR 4.7, p = 0.02).


MDCT is a useful diagnostic and prognostic tool for evaluating patients with immune checkpoint inhibitor-related colitis. An MDCT-based severity score enables assessment of disease severity and predicts outcome.

Key Points

• MDCT is useful for the diagnosis of colitis in patients receiving immune checkpoint inhibitor (ICI) therapy, and an MDCT-based severity score allows for prognostication of patient outcomes.

• MDCT yielded moderate sensitivity (81%) for diagnosis of ICI-related colitis but limited specificity (52%). However, in symptomatic melanoma patients (grade 2–4 diarrhea) with a high pretest probability, MDCT proved useful for diagnosis with a high PPV (92%).

• For ICI-related colitis, our proposed MDCT severity score has prognostic value in predicting intravenous steroid use, prolonged length of stay during inpatient admission (> 7 days), and endoscopic mucosal ulceration.

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Anti-cytotoxic T-lymphocyte antigen-4


Anti-programmed cell death protein 1


Anti-programed cell death ligand 1


American Society of Clinical Oncology


Common Terminology Criteria for Adverse Events

CTLA-4 :

Cytotoxic T-lymphocyte antigen-4


United States Food and Drug Administration


Health Insurance Portability and Account Act


Immune checkpoint inhibitor


Immune-related adverse events


Multi-detector computed tomography


Negative predictive value


Positive predictive value


Segmental colitis associated with diverticulosis


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The authors would like to thank Susanne Loomis for medical illustration.


The authors state that this work has not received any funding.

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Correspondence to Avinash Kambadakone.

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The scientific guarantor of this publication is Avinash Kambadakone.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

MJM is a consultant and received honoraria from AstraZeneca, Nektar Pharmaceutics, and Immunai. MD is a consultant for Tillotts Pharma, Partner Therapeutics, and Genentech-Roche, receives research funding from Novartis, and is on the Scientific Advisory Board for Neoleukin. AK receives a research grant from GE Healthcare, Philips, and PanCAN. All other authors declare no competing interests.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

The study subjects or cohorts were a subgroup of patients from the prior published paper and have been previously reported in Journal for Immunotherapy of Cancer.

Durbin SM, Mooradian MJ, Fintelmann FJ, et al Diagnostic utility of CT for suspected immune checkpoint inhibitor enterocolitis. J Immunother Cancer. 2020;8:e001329.


• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Pisuchpen, N., Durbin, S.M., Mooradian, M.J. et al. Multi-detector computed tomography (MDCT)–based severity score as a prognostic tool in patients with suspected immune checkpoint inhibitor therapy associated colitis. Eur Radiol 31, 8868–8878 (2021).

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