[18F]FDG uptake of axillary lymph nodes after COVID-19 vaccination in oncological PET/CT: frequency, intensity, and potential clinical impact

Skawran, Stephan; Gennari, Antonio Giulio; Dittli, Manuel; Treyer, Valérie; Muehlematter, Urs J.; Maurer, Alexander; Burger, Irene A.; Mader, Cäcilia; Messerli, Olivia; Grünig, Hannes; Gebhard, Cathérine; Huellner, Martin W.; Curioni-Fontecedro, Alessandra; Berger, Christoph; Messerli, Michael

doi:10.1007/s00330-021-08122-2

Cited by 47 publications

(58 citation statements)

References 17 publications

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“…Skawran et al [ 13 ] reported that vaccination-induced FDG uptake in the ALN was more frequent for the mRNA-1273 vaccine (Moderna) than for the BNT162b2 vaccine (Pfizer). Puranik et al [ 22 ] compared the differences of these two full-length Spike protein-encoding mRNA vaccines, which are both highly effective against COVID-19 infection and preventing hospitalization, with a slightly higher effectiveness observed for the Moderna vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…Naturally, we have faced to a lot of episodes and information not only of the adverse reactions but also of the influence on radiological imaging. Several case reports [ 1 – 7 ], radiology panel reports [ 8 ], suggestions [ 9 ], a few cohort studies [ 10 – 13 ], and a review [ 14 ] have already been reported on the influence of COVID-19 vaccination on radiological imaging, especially on FDG-PET/CT.…”

Section: Introductionmentioning

confidence: 99%

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[18F]FDG uptake in axillary lymph nodes and deltoid muscle after COVID-19 mRNA vaccination: a cohort study to determine incidence and contributing factors using a multivariate analysis

et al. 2022

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Purpose Reactive FDG uptake in the axillary lymph nodes (ALN) and deltoid muscle (DM) after COVID-19 mRNA vaccination has been recognized, although the actual situation in the Japanese population remains unknown. To determine the incidence of reactive FDG uptake and its contributing factors, we retrospectively studied a cohort of subjects who were vaccinated at our hospital. Methods Whole-body FDG-PET/CT examinations performed in 237 subjects out of 240 subjects with a definite history of COVID-19 vaccination (BNT162b2; BioNTech-Pfizer) were analyzed. Positivity and SUVmax of FDG uptake in the ALN and DM ipsilateral to vaccination, various subject characteristics, and the grade of the pathological FDG-PET/CT findings were evaluated using a multivariate analysis. Results FDG uptake in the ALN and DM ipsilateral to vaccination was seen in about 60% of the subjects even soon (0–4 days) after the first vaccination, with percentages reaching 87.5% and 75.0%, respectively, after the second vaccination. DM uptake had almost disappeared at around 2 weeks, while ALN uptake persisted for 3 weeks or longer. A multivariate analysis showed that a short duration since vaccination, a younger age, a female sex, and a low FDG-PET/CT grade (minimal pathological FDG uptake) contributed significantly to positive ALN uptake, while a short duration since vaccination and a female sex were the only significant contributors to positive DM uptake. This study is the first to identify factors contributing to positive FDG uptake in ALN and DM after COVID-19 vaccination. Conclusion A high incidence of FDG uptake in ALN and DM was observed after vaccination. ALN uptake seemed to be associated with a younger age, a female sex, and minimal pathological FDG uptake. After vaccination, an acute inflammatory reaction in DM followed by immune reaction in ALN linked to humoral immunity may be speculated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

[18F]FDG uptake in axillary lymph nodes and deltoid muscle after COVID-19 mRNA vaccination: a cohort study to determine incidence and contributing factors using a multivariate analysis

et al. 2022

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“…Our Patient 6 demonstrates similar findings of increased FDG uptake in normal sized axillary nodes 15 days after ipsilateral injection of 1st dose Moderna vaccine. While there are now multiple studies describing COVID-19 vaccination-related adenopathy on FDG PET-CT [ 14 15 ], the duration of vaccine-related FDG-avid nodal uptake remains not clearly defined. FDG nodal uptake has been previously reported up to 7 days after influenza vaccination and 1–14 days after H1N1 vaccination [ 11 16 17 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine-Related Axillary and Cervical Lymphadenopathy in Patients with Current or Prior Breast Cancer and Other Malignancies: Cross-Sectional Imaging Findings on MRI, CT, and PET-CT

Lane

Neelapu

et al. 2021

Korean J Radiol

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Breast radiologists are increasingly seeing patients with axillary adenopathy related to COVID-19 vaccination. Vaccination can cause levels I–III axillary as well as cervical lymphadenopathy. Appropriate management of vaccine-related adenopathy may vary depending on clinical context. In patients with current or past history of malignancy, vaccine-related adenopathy can be indistinguishable from nodal metastasis. This article presents imaging findings of oncology patients with adenopathy seen in the axilla or neck on cross-sectional imaging (breast MRI, CT, or PET-CT) after COVID-19 vaccination. Management approach and rationale is discussed, along with consideration on strategies to minimize false positives in vaccinated cancer patients. Time interval between vaccination and adenopathy seen on breast MRI, CT, or PET-CT is also reported.

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“…The characteristics of VAHL following the first and second vaccine doses were reported to be different [8,10,16]. This probably reflects the difference between the immune response elicited by a first vaccine dose and the amnestic response induced by a booster given 3 weeks later.…”

Section: Discussionmentioning

confidence: 99%

“…Eshet et al reported that VAHL persisted in 29% of patients between 7 and 10 weeks after the second BNT162b2 dose [9]. Following the administration of the Moderna mRNA-1273 vaccine, Skawran et al reported a VAHL incidence of 72% [10]. The finding of VAHL was found relevant when interpreting [ 18 F]FDG PET-CT of oncologic patients [8,[10][11][12][13], more commonly in patients with breast cancer, lymphoma, and malignancies of the upper limb, when "hot" axillary nodes may reflect malignant involvement [8].…”

Section: Introductionmentioning

confidence: 99%

A sigh of relief: vaccine-associated hypermetabolic lymphadenopathy following the third COVID-19 vaccine dose is short in duration and uncommonly interferes with the interpretation of [18F]FDG PET-CT studies performed in oncologic patients

Cohen

Krauthammer

Wolf

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose The incidence of COVID-19 vaccine-associated hypermetabolic lymphadenopathy (VAHL) is high following the administration of the first and second BNT162b2 vaccine doses. The impact of this finding on [ 18 F]FDG PET-CT interpretation and its correlation with the induced humoral immunity have been reported. Assuming the amnestic immune response is different following the third vaccine dose, we aimed to explore the incidence of VAHL over time after the third BNT162b2 dose administration, and its relevance to [ 18 F]FDG PET-CT interpretation in oncologic patients. Methods A total of 179 consecutive oncologic patients that underwent [ 18 F]FDG PET-CT after a third BNT162b2 vaccine dose were included. The presence of VAHL was assessed. On VAHL-positive scans, the SUVmax, number, location, and size of the "hot" nodes were recorded. The median time interval between vaccination and imaging was 8 (IQR, 5-14) days. ResultsThe incidences of all-grade VAHL and grade 3-4 VAHL were 47.5% and 8.9%, respectively. VAHL was identified on 82.5% of studies performed within the first 5 days from vaccination. Grade 3-4 VAHL was observed on 28.1% of studies performed within the first 5 days from vaccination, but was not detected on studies performed more than 5 days from vaccination. Separation between VAHL and malignant lymphadenopathy was not possible in only 2 of the 179 study patients. On a multivariable logistic regression, independent predictors of grade 3-4 VAHL were short time interval between vaccination and imaging (Pv < 0.01), younger age (Pv < 0.01), and lower BMI (Pv = 0.03). Conclusion VAHL is commonly identified on [ 18 F]FDG PET-CT performed within the first 5 days from the third BNT162b2 vaccine dose administration. High-grade VAHL is unlikely to be observed on a scan performed 6 days or longer from vaccination, and is even less likely in older and obese patients.

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[18F]FDG uptake of axillary lymph nodes after COVID-19 vaccination in oncological PET/CT: frequency, intensity, and potential clinical impact

Cited by 47 publications

References 17 publications

[18F]FDG uptake in axillary lymph nodes and deltoid muscle after COVID-19 mRNA vaccination: a cohort study to determine incidence and contributing factors using a multivariate analysis

[18F]FDG uptake in axillary lymph nodes and deltoid muscle after COVID-19 mRNA vaccination: a cohort study to determine incidence and contributing factors using a multivariate analysis

COVID-19 Vaccine-Related Axillary and Cervical Lymphadenopathy in Patients with Current or Prior Breast Cancer and Other Malignancies: Cross-Sectional Imaging Findings on MRI, CT, and PET-CT

A sigh of relief: vaccine-associated hypermetabolic lymphadenopathy following the third COVID-19 vaccine dose is short in duration and uncommonly interferes with the interpretation of [18F]FDG PET-CT studies performed in oncologic patients

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