Evolution of Lymphadenopathy at PET/MRI after                      COVID-19 Vaccination

Hanneman, Kate; Iwanochko, Robert M.; Thavendiranathan, Paaladinesh

doi:10.1148/radiol.2021210386

Cited by 25 publications

(42 citation statements)

References 4 publications

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“…Three cases were subsequently reported in patients undergoing screening breast MRI [7,8] and two in patients undergoing chest CT [8]. At this time, several subsequent cases of benign UAL after COVID-19 vaccination have been published [9][10][11][12][13].…”

Section: Postvaccination Lymphadenopathy On Imagingmentioning

confidence: 99%

“…In this early phase of COVID-19 vaccinations, management plans for UAL in the clinical setting of recent vaccination vary widely across practices and include assessment as "benign" or "normal" with or without clinical follow-up, immediate additional imaging, short-interval follow-up imaging (until resolution is documented), and biopsy [6][7][8][9][10][11][12][13][22][23][24].…”

Section: Management Recommendations: Overviewmentioning

confidence: 99%

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Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties

Lehman

D’Alessandro

Mendoza

et al. 2021

Journal of the American College of Radiology

119

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Reports are rising of patients with unilateral axillary lymphadenopathy, visible on diverse imaging examinations, after recent coronavirus disease 2019 vaccination. With less than 10% of the US population fully vaccinated, we can prepare now for informed care of patients imaged after recent vaccination. The authors recommend documenting vaccination information (date[s] of vaccination[s], injection site [left or right, arm or thigh], type of vaccine) on intake forms and having this information available to the radiologist at the time of examination interpretation. These recommendations are based on three key factors: the timing and location of the vaccine injection, clinical context, and imaging findings. The authors report isolated unilateral axillary lymphadenopathy (i.e., no imaging findings outside of visible lymphadenopathy), which is ipsilateral to recent (prior 6 weeks) vaccination, as benign with no further imaging indicated. Clinical management is recommended, with ultrasound if clinical concern persists 6 weeks after the final vaccination dose. In the clinical setting to stage a recent cancer diagnosis or assess response to therapy, the authors encourage prompt recommended imaging and vaccination (possibly in the thigh or contralateral arm according to the location of the known cancer). Management in this clinical context of a current cancer diagnosis is tailored to the specific case, ideally with consultation between the oncology treatment team and the radiologist. The aim of these recommendations is to (1) reduce patient anxiety, provider burden, and costs of unnecessary evaluation of enlarged nodes in the setting of recent vaccination and (2) avoid further delays in vaccinations and recommended imaging for best patient care during the pandemic.

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Section: Postvaccination Lymphadenopathy On Imagingmentioning

confidence: 99%

Section: Management Recommendations: Overviewmentioning

confidence: 99%

Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties

Lehman

D’Alessandro

Mendoza

et al. 2021

Journal of the American College of Radiology

119

View full text Add to dashboard Cite

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“…Several case reports and small cohort studies have already highlighted the medical imaging identification of vaccineassociated lymphadenopathy post-anti-SARS-CoV-2 vaccines [6][7][8][9][10][11][12][13][14][15][16][17][18]. Specifically, a very recent special report published by Radiology scientific expert panel explores the concern of accurate imaging report in view of lymphadenopathy associated with vaccination, although, as the authors state, the proportion of patients experiencing some form of lymphadenopathy is not available.…”

Section: Introductionmentioning

confidence: 99%

Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: incidence assessed by [18F]FDG PET-CT and relevance to study interpretation

Cohen

Krauthammer

Wolf

et al. 2021

Eur J Nucl Med Mol Imaging

118

177

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Purpose Nationwide mass vaccination against Covid-19 started in Israel in late 2020. Soon we identified on [18F]FDG PET-CT studies vaccine-associated hypermetabolic lymphadenopathy (VAHL) in axillary or supraclavicular lymph nodes (ASLN) ipsilateral to the vaccination site. Sometimes, differentiation between the malignant and benign nature of the hypermetabolic lymphadenopathy (HLN) could not be made, and equivocal HLN (EqHL) was reported. The purpose of the study was to determine the overall incidence of VAHL after BNT162b2 vaccination and also its relevance to PET-CT interpretation in oncologic patients. Methods A total of 951 consecutive patients that underwent [18F]FDG PET-CT studies in our department were interviewed regarding the sites and dates of the vaccine doses. A total of 728 vaccinated patients (All-Vac group) were included: 346 received the first dose only (Vac-1 group) and 382 received the booster dose as well (Vac-2 group). Studies were categorized as no HLN, malignant-HLN (MHL), VAHL, or EqHL. In studies with VAHL, location, [18F]FDG-intensity uptake and nodes size were recorded. Results The incidences of HLN were 45.6%, 36.4%, and 53.9% in All-Vac, Vac-1, and Vac-2 groups, respectively. VAHL was reported in 80.1% of vaccinated patients with HLN. Lower incidences of VAHL were found during the first 5 days or in the third week after the first vaccine and beyond 20 days after the booster dose. In 49 of 332 (14.8%) vaccinated patients, we could not determine whether HLN was MHL or VAHL. Breast cancer and lymphoma were the leading diseases with EqHL. Conclusion VAHL is frequently observed after BNT162b2 administration, more commonly and with higher intensity following the booster dose. To minimize false and equivocal reports in oncological patients, timing of [18F]FDG PET-CT should be based on the time intervals found to have a lower incidence of VAHL, and choice of vaccine injection site should be advised, mainly in patients where ASLN are a relevant site of tumor involvement.

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“…In light of such results, several groups advise patients to consider the timing of Covid-19 vaccination relative to their anti-CD20 antibody therapy schedule [9][10][11]. Detection of regional lymphadenopathy after Covid-19 vaccines on various imaging modalities has been reported in case reports and small cohorts [13][14][15][16][17][18][19][20][21][22][23][24][25]. Recently, our group reported the incidence and time of appearance of BNT162b2 vaccine-associated hypermetabolic lymphadenopathy (VAHL) on [ 18 F]FDG PET-CT [26].…”

Section: Introductionmentioning

confidence: 99%

Correlation Between BNT162b2 mRNA Covid-19 Vaccine-associated Hypermetabolic Lymphadenopathy and Humoral Immunity in Patients With Hematologic Malignancy

Cohen

Krauthammer

Cohen

et al. 2021

Preprint

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Purpose: Vaccine-associated hypermetabolic lymphadenopathy (VAHL) is frequently observed on [18F]FDG PET-CT following BNT162b2 administration. Recent data suggest a prominent B-cell germinal-center (GC) response elicited by mRNA vaccines in draining lymph nodes. Thus, in this study we aimed to explore the correlation between VAHL and humoral immunity as reflected by post-vaccination serologic testing, and by comparing the incidence of VAHL between lymphoma patients treated recently with B-cell depleting therapy and those that did not. Methods: A total of 137 patients with hematologic malignancy that had post-vaccination [18F]FDG PET-CT were included (All-PET group), 86 received both vaccine doses before imaging (PET-2 group). Their VAHL status and grade on imaging were recorded. Among 102 lymphoma patients, 34 (33.3%) were treated during the year prior vaccination with anti-CD20 antibody containing therapy. A subgroup of 54 patients also underwent serologic testing 2-3 weeks after the booster dose, and their anti-spike titers were recorded and graded as well.Results: The overall incidence of VAHL in patients with hematologic malignancy was 31.4%. The 34 lymphoma patients treated during the year prior vaccination with anti-CD20 antibody containing therapy had significantly lower rates of VAHL comparted to all other lymphoma patients (8.8% versus 41.2% in all-PET patients, Pv < 0.01). VAHL rates were 10% in patients with negative serology, 31.3% in patients with low anti-spike titers and 72.2% in patients with high anti-spike titers. The positive predictive values of VAHL were 90% and 93.3% in all-PET and PET-2 patients, respectively. A positive statistically significant correlation was found between VAHL and serology ranks in All-PET patients (rs = 0.530, Pv < 0.001), and stronger correlation was found in PET-2 patients (rs = 0.642, Pv < 0.001).Conclusion: VAHL on [18F]FDG PET-CT of patients with hematologic malignancy may reflect GC B-cell proliferation and an effective humoral response elicited by BNT162b2 vaccine.

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Evolution of Lymphadenopathy at PET/MRI after COVID-19 Vaccination

Cited by 25 publications

References 4 publications

Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties

Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties

Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA Covid-19 vaccine: incidence assessed by [18F]FDG PET-CT and relevance to study interpretation

Correlation Between BNT162b2 mRNA Covid-19 Vaccine-associated Hypermetabolic Lymphadenopathy and Humoral Immunity in Patients With Hematologic Malignancy

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