Rearranged during transfection proto-oncogene ( ) fusions represent a potentially targetable oncogenic driver in non-small cell lung cancer (NSCLC). Imaging features and metastatic patterns of advanced fusion-positive ( +) NSCLC are not well established. Our goal was to compare the imaging features and patterns of metastases in +, + and + NSCLC. Patients with +, +, or + NSCLC seen at our institution between January 2014 and December 2018 with available pre-treatment imaging were identified. The clinicopathologic features, imaging characteristics, and the distribution of metastases were reviewed and compared. We identified 215 patients with NSCLC harboring , , or gene fusion ( = 32; = 116; = 67). Patients with + NSCLC were older at presentation compared to + and + patients (median age: = 64 years; = 51 years, < 0.001; ROS = 54 years, = 0.042) and had a higher frequency of neuroendocrine histology ( = 12%; = 2%, = 0.025; = 0%, = 0.010). Primary tumors in + patients were more likely to be peripheral ( = 69%; = 47%, = 0.029; = 36%, = 0.003), whereas lobar location, size, and density were comparable across the three groups. + NSCLC was associated with a higher frequency of brain metastases at diagnosis compared to + NSCLC ( = 32%, = 10%; = 0.039. Metastatic patterns were otherwise similar across the three molecular subgroups, with high incidences of lymphangitic carcinomatosis, pleural metastases, and sclerotic bone metastases. + NSCLC shares several distinct radiologic features and metastatic spread with + and NSCLC. These features may suggest the presence of fusions and help identify patients who may benefit from further molecular genotyping.