细胞因子是一种小型分泌蛋白，对细胞间的相互作用有特殊作用，对免疫系统的运作至关重要。几乎所有疾病都与细胞因子有关，但由于显而易见的原因，细胞因子作为微小的化学物质无法通过成像进行观察。由于细胞因子疗法的发展（如贝伐珠单抗（血管内皮生长因子抗体）和嵌合抗原受体（CAR）T 细胞）以及新疾病概念（如干扰素病和细胞因子释放综合征）的确立，一些影像学表现已得到广泛认可。例如，免疫效应细胞相关神经毒性是仅次于 CAR T 细胞疗法毒性的第二大常见毒性形式，建议使用成像技术评估其严重程度。导致细胞因子风暴的 COVID-19 的出现对神经影像学产生了深远影响。中枢神经系统是最容易受到细胞因子风暴影响的系统之一，细胞因子风暴是由炎症细胞因子的正反馈诱发的。细胞因子风暴会引起多种神经系统并发症，包括急性脑梗塞、急性白质脑病和灾难性出血，导致破坏性的神经系统后果。影像学可用于检测这些异常并描述其严重程度，还有助于区分代谢性脑病和脑血管病等模拟病。熟悉细胞因子风暴导致的神经影像学异常有利于诊断此类疾病，进而规划和启动早期治疗策略。作者概述了细胞因子相关疾病的神经影像学特征，重点关注细胞因子风暴、神经炎症和神经退行性疾病、细胞因子相关肿瘤以及细胞因子相关疗法，并介绍了诊断细胞因子相关疾病过程及其鉴别的方法。
Neuroimaging Features of Cytokine-related Diseases
Cytokines are small secreted proteins that have specific effects on cellular interactions and are crucial for functioning of the immune system. Cytokines are involved in almost all diseases, but as microscopic chemical compounds they cannot be visualized at imaging for obvious reasons. Several imaging manifestations have been well recognized owing to the development of cytokine therapies such as those with bevacizumab (antibody against vascular endothelial growth factor) and chimeric antigen receptor (CAR) T cells and the establishment of new disease concepts such as interferonopathy and cytokine release syndrome. For example, immune effector cell–associated neurotoxicity is the second most common form of toxicity after CAR T-cell therapy toxicity, and imaging is recommended to evaluate the severity. The emergence of COVID-19, which causes a cytokine storm, has profoundly impacted neuroimaging. The central nervous system is one of the systems that is most susceptible to cytokine storms, which are induced by the positive feedback of inflammatory cytokines. Cytokine storms cause several neurologic complications, including acute infarction, acute leukoencephalopathy, and catastrophic hemorrhage, leading to devastating neurologic outcomes. Imaging can be used to detect these abnormalities and describe their severity, and it may help distinguish mimics such as metabolic encephalopathy and cerebrovascular disease. Familiarity with the neuroimaging abnormalities caused by cytokine storms is beneficial for diagnosing such diseases and subsequently planning and initiating early treatment strategies. The authors outline the neuroimaging features of cytokine-related diseases, focusing on cytokine storms, neuroinflammatory and neurodegenerative diseases, cytokine-related tumors, and cytokine-related therapies, and describe an approach to diagnosing cytokine-related disease processes and their differentials.
期刊介绍：
Launched by the Radiological Society of North America (RSNA) in 1981, RadioGraphics is one of the premier education journals in diagnostic radiology. Each bimonthly issue features 15–20 practice-focused articles spanning the full spectrum of radiologic subspecialties and addressing topics such as diagnostic imaging techniques, imaging features of a disease or group of diseases, radiologic-pathologic correlation, practice policy and quality initiatives, imaging physics, informatics, and lifelong learning.
A special issue, a monograph focused on a single subspecialty or on a crossover topic of interest to multiple subspecialties, is published each October.
Each issue offers more than a dozen opportunities to earn continuing medical education credits that qualify for AMA PRA Category 1 CreditTM and all online activities can be applied toward the ABR MOC Self-Assessment Requirement.
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