Imaging of Immune Checkpoint Inhibitor–Related Pulmonary Toxicity: A Narrative Review of Current Evidence and Emerging Roles of Radiomics and Machine Learning

The advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, offering an effective therapeutic option for advanced cancers. However, their widespread use has led to the occurrence of immune-related adverse events (irAEs), including pulmonary toxicity. ICI-induced pulmonary toxicity represents one of the most relevant irAEs because of its heterogeneous clinical and radiological presentation and its potential life-threatening course. Computed tomography (CT) is the imaging modality of choice for evaluating lung irAEs and the specific patterns associated with ICI-induced pneumonitis. A literature search of the PubMed and Scopus databases was conducted to identify studies published over the past decade investigating pulmonary adverse effects associated with ICI therapy. Relevant studies were reviewed with particular attention to the clinical and radiological features of ICI-induced pulmonary toxicity, including the main CT patterns of pneumonitis and the emerging applications of radiomics and machine learning. This narrative review aims to provide a comprehensive overview of the current evidence on the radiological manifestations of lung irAEs, with particular emphasis on CT findings and radiomics and its potential role in the prediction and diagnosis of lung irAEs. Ultimately, this research highlights the importance of a multidisciplinary approach in the diagnosis and management of ICI-induced pulmonary toxicity, with radiologists playing a critical role in identifying and monitoring these potentially life-threatening events.