E1381. Chemotherapy-Induced Toxicities: An Imaging Primer
  1. Natasha Larocque; McMaster University
  2. Nikhil Patil; McMaster University
  3. Christian van der Pol; McMaster University
  4. Carlos Torres; University of Ottawa
  5. Demetrios Raptis; Washington University School of Medicine
  6. Michael Patlas; McMaster University
The Coronavirus Disease of 2019 (COVID-19) pandemic caused significant delays in the delivery of cancer treatments. As cancer treatment and imaging volumes return to normal, radiologists will encounter more cases of chemotherapy-induced toxicities. These toxicities have varied appearances on imaging and can affect multiple organ systems. Furthermore, novel chemotherapy agents, such as immune checkpoint inhibitors and monoclonal antibodies, can cause complications not previously seen with traditional chemotherapy agents. The purpose of this educational exhibit is to offer a unified resource for general radiologists and trainees regarding the varied imaging appearances of chemotherapy-induced toxicities.

Educational Goals / Teaching Points
To review the possible imaging appearances of chemotherapy-induced toxicities using a head-to-toe approach.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will briefly review different classes of chemotherapy agents. We will then outline abdominal manifestations of chemotherapy-induced toxicities which include: neurologic - (brain: toxic leukoencephalopathy, posterior reversible encephalopathy syndrome, hypophysitis, cerebral venous sinus thrombosis); spine (myelopathy); peripheral nervous system (peripheral neurotoxicity); thyroid (thyroiditis); chest - lungs (pneumonitis, non-specific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, hypersensitivity pneumonitis, capillary leak syndrome); pleura (pleural effusions); vascular system (atherosclerosis, arterial thromboembolisms, venous thromboembolisms); heart (cardiomyopathy, pericardial effusions, pericardial disease); abdominal - liver (acute hepatocellular injury, steatosis/steatohepatitis, sinusoidal obstruction syndrome); biliary tree (cholecystitis, biliary tree inflammation, biliary sclerosis); pancreas (pancreatitis, pancreatic atrophy); spleen (splenomegaly); kidneys (interstitial nephritis, papillary necrosis, acute tubular necrosis, renal infarcts, complex renal cysts); adrenal glands: adrenal insufficiency); gastrointestinal tract: enteritis, ileus, pneumatosis, neutropenic enterocolitis, intestinal perforation, gastrointestinal bleeding); urinary bladder (hemorrhagic cystitis); peritoneum (ascites, capillary leak syndrome); musculoskeletal and skin - muscles (cachexia); bones (osteoporosis, osteonecrosis); and skin/other soft tissues (edema, gynecomastia, squamous cell carcinoma).

Chemotherapy-related toxicities have manifestations across many organ systems. Knowledge of medication history is key in making a diagnosis of chemotherapy-related toxicity as other differentials include disease progression or infection.