rearrangements are an established targetable oncogenic driver in non-small cell lung cancer (NSCLC). The goal of this study was to determine the imaging features of the primary tumor and metastatic patterns in advanced -rearranged ( +) NSCLC that may be different from those in -mutant ( +) or wild-type ( -/ -) NSCLC. Patients with advanced +, +, or NSCLC were retrospectively identified. Two radiologists concurrently assessed the imaging features of the primary tumor and the distribution of metastases in these patients. We identified a cohort of 333 patients with metastatic NSCLC (119 cases, 116 cases, and 98 -/ - cases). Compared with + and -/ - NSCLC, the primary tumor in + NSCLC was more likely to be located in the lower lobes (53% of , 34% of , and 36% of -/ - tumors; < 0.05), less likely to be subsolid (1% of +, 11% of , and 8% of -/ - tumors; < 0.02), and less likely to have air bronchograms (7% of , 28% of , and 29% of -/ - tumors; < 0.01). Compared with + and -/ - tumors, + tumors had higher frequencies of distant nodal metastasis (20% of tumors vs 2% of and 9% of -/ - tumors; < 0.05) and lymphangitic carcinomatosis (37% of tumors vs 12% of and 12% of -/ - tumors; < 0.01), but + tumors had a lower frequency of brain metastasis compared with + tumors (24% vs 41%; = 0.01). Although there was no statistically significant difference in the frequencies of bone metastasis among the three groups, sclerotic bone metastases were more common in the + tumors (22% vs 7% of tumors and 6% of -/ - tumors; < 0.01). Advanced + NSCLC has primary tumor imaging features and patterns of metastasis that are different from those of + or -/ - wild type NSCLC at the time of initial presentation.