COVID-19 mRNA Vaccination: Age and Immune Status and Its Association with Axillary Lymph Node PET/CT Uptake

Eifer, Michal; Tau, Noam; Alhoubani, Yousef; Kanana, Nayroz; Domachevsky, Liran; Shams, Jala; Keret, Nir; Gorfine, Malka; Eshet, Yael

doi:10.2967/jnumed.121.262194

Cited by 57 publications

(103 citation statements)

References 19 publications

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“…The previously described association between VAHL and immunogenicity [14,15] may be implied alsoin the results of the current study. Older age [17] and obesity [18] were both reportedto be associated with weaker vaccine-induced immunity.…”

Section: Discussionsupporting

confidence: 83%

“…The current study demonstrates that the overall incidence of any-grade VAHL following the third Covid-19 vaccine dose is basically similar to that reported following the rst and second Covid-19 vaccine doses [8][9][10][14][15][16]. However, VAHL cases following the third dose were found to have shorter duration andlow uptake intensity after the rst 5 days from vaccination.…”

Section: Discussionsupporting

confidence: 76%

“…In a studyour group conducted on patients with hematologic malignancy, we presented thepositive correlation between the imaging nding of VAHL andthe post-vaccination antibody titers.We concluded that VAHL on imaging may re ect a potent germinal center response in lymph nodes draining the vaccine injection site [14]. The relationship between VAHL and immune status was observed by Eifer et al as well [15].…”

Section: Introductionsupporting

confidence: 56%

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A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

Preprint

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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 [18F]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 [18F]FDGPET-CT interpretation in oncologic patients.Methods: A total of 179 consecutive oncologic patients that underwent [18F]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 imagingwas 8 (IQR,5-14) days.Results: The 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 identifiedon [18F]FDG PET-CT performed within the first 5 days from the third BNT162b2 vaccine doseadministration. 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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Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 76%

Section: Introductionsupporting

confidence: 56%

See 1 more Smart Citation

A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

Preprint

View full text Add to dashboard Cite

show abstract

“…We concluded that VAHL on imaging may reflect a potent germinal center response in lymph nodes draining the vaccine injection site [14]. The relationship between VAHL and immune status was observed by Eifer et al as well [15].…”

Section: Introductionsupporting

confidence: 60%

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

View full text Add to dashboard Cite

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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“…Potential pitfalls in the diagnostic of PET/ CT are well known, especially after vaccination [1]. Eifer et al showed FDG-uptake of axillary lymph nodes in 45 % of patients after mRNA-COVID-19 vaccination in the ipsilateral upper arm [2]. Several cases presented high FDG-uptake after COVID-19 vaccination in axillary lymph nodes, mentioning the potential danger in interpreting these lymph nodes correctly, but only few with histopathological confirmation [3,4].…”

Section: Discussionmentioning

confidence: 99%

FDG uptake in axillary lymph nodes after COVID-19 vaccination – a pitfall in a case of highly suspicious lymph node metastases of malignant melanoma

et al. 2021

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COVID-19 mRNA Vaccination: Age and Immune Status and Its Association with Axillary Lymph Node PET/CT Uptake

Abstract: Visual Abstract

Cited by 57 publications

References 19 publications

A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

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

FDG uptake in axillary lymph nodes after COVID-19 vaccination – a pitfall in a case of highly suspicious lymph node metastases of malignant melanoma

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