COVID-19 vaccine-related lymph node activation – patterns of uptake on PET-CT

Shah, Sweni; Wagner, Thomas; Nathan, Malavika; Szyszko, Teresa

doi:10.1259/bjrcr.20210040

Cited by 12 publications

(8 citation statements)

References 20 publications

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“…We agree with the report by Shah et al [ 4 ] that information regarding vaccination history, site of injection, and the nature of vaccine-associated lymph adenopathy is important; furthermore, clusters of small lymph nodes with a normal structure (preserved fat in the hilum of the lymph node) may help prevent misinterpretations of reactive lymphadenopathy. However, Cohen et al [ 10 ] reported that they could not differentiate vaccine-associated lymphadenopathy from metastatic lymphadenopathy in 14.8% of vaccinated patients.…”

Section: Discussionsupporting

confidence: 92%

[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: Discussionsupporting

confidence: 92%

[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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“…Its uptake has already been described in both benign tumors 27 and malignancies, 28,29 as well as in inflammatory sites, which were by far the most frequent situations. [30][31][32] This may be explained by an increased need for membrane synthesis in case of intense proliferation of immune cells, as generally observed in activated LNs, 33,34 leading to an increased uptake of 18 F-FCH. 35,36 Our cohort managed to find some rare cases of vaccinerelated LNs detected in 68 Ga-PSMA-11 PET/CT.…”

Section: Discussionmentioning

confidence: 99%

Vaccine-Related Lymph Nodes

et al. 2022

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Purpose: Vaccination against coronavirus disease 2019 (COVID-19) is currently under worldwide deployment. The consequences of this vaccination can be seen in radiology and nuclear medicine explorations with visualization of axillary lymph nodes (LNs), as observed on ultrasonography, MRI, or 18 F-FDG PET/CT.We aimed to evaluate on PET/CT the incidence of vaccine-related LNs and their characteristics after COVID-19 vaccination, using several radiopharmaceuticals different from 18 F-FDG. Patients and Methods: Between February and July 2021, all consecutive patients undergoing a whole-body PET/CT for any indication using a different radiopharmaceutical from 18 F-FDG were eligible for inclusion if they had received at least 1 dose of the COVID-19 vaccine. The radiopharmaceutical administered and vaccine type were recorded for each patient. The incidence of positive vaccine-related axillary and supraclavicular LNs on PET/CT was our primary finding, along with the nodes characteristics. Statistical analyses were performed for patients with prostate cancer (PCa) to determine certain interaction factors that were associated with the detection of vaccine-related LNs. Results: Of the 226 patients in our cohort study, 120 patients underwent an 18 F-fluorocholine PET/CT, 79 a 68 Ga-PSMA-11 PET/CT, 6 an 18 F-FDOPA PET/CT, and 21 a 68 Ga-DOTATOC PET/CT. A total of 67.3% of patients (152/226) received BNT162b2mRNA (Pfizer-BioNTech), 26.5% (60/226) ChAdOx1-S (AstraZeneca), 4.9% (11/226) mRNA-1273 (Moderna), and 1.3% (3/226) Ad26.COV2.S (Janssen). The incidence of positive vaccine-related axillary and supraclavicular LNs was 42.5% (51/120 patients) on PET/CT using 18 F-fluorocholine and 12.7% (10/79 patients) with 68 Ga-PSMA-11. None of our patients undergoing 18 F-FDOPA or 68 Ga-DOTATOC PET/CT presented any vaccine-related lymphadenopathy. Vaccine-related LNs were statistically associated with the nature of the radiopharmaceutical ( P < 10 −4 ), with the number of vaccine doses received ( P = 0.041), with a short delay between vaccination and PET/CT realization ( P < 10 −5 ), and with a higher prostate-specific antigen level for patients with PCa ( P = 0.032), but not with age or vaccine type. The vaccine-related nodes appeared in 85% of the cases, in the 30 days after vaccine injection, were limited in size and uptake, and were most often limited to the axilla level 1 area. Conclusions: Detecting positive LNs after COVID-19 vaccination is not an exclusive 18 F-FDG PET/CT pattern but is common on 18 F-fluorocholine and possible on 68 Ga-PSMA-11 PET/CT. Confronting PET/CT findings with clinical data (such as date and site of injection) seems essential in the current pandemic context, just as it does for the radiopharmaceuticals used in PCa to avoid PET/CT misinterpretation and incorrect patient treatment. For 18 F-FDOPA or 68 Ga-DOTATOC PET/CT, this seems to have a lesser impact.

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“…Although there are multiple studies recognizing COVID-19 vaccine associated lymphadenopathy 4 , 5 , 6 , 7 , to our knowledge, to date, there is no current detailed study addressing its timeline and the degree of metabolic activity. Locally, COVID-19 vaccine associated lymphadenopathy is a commonly encountered clinical scenario.…”

Section: Introductionmentioning

confidence: 99%

Intensity of hypermetabolic axillary lymph nodes in oncologic patients in relation to timeline following COVID-19 vaccination

Wiefels

Klein

et al. 2022

Journal of Medical Imaging and Radiation Sciences

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Résumé Bute : Découvert pour la première fois à Wuhan, en Chine, en décembre 2019, le coronavirus 2 du syndrome respiratoire aigu sévère (SRAS-COV-2) est un nouveau virus très contagieux et mortel qui a rapidement fait des ravages dans le monde entier. Alors que la vaccination de masse est en cours dans le monde entier, les cliniciens ont commencé à rencontrer une nouvelle entité clinique, la lymphadénopathie axillaire associée au vaccin COVID-19. Cela représente un défi unique pour les imageurs médicaux, en particulier chez les patients oncologiques. Méthodologie : Dans cette étude rétrospective, nous avons évalué l'activité métabolique, la taille et la chronologie des ganglions lymphatiques axillaires hypermétaboliques associés au vaccin COVID-19 chez 202 patients oncologiques après la vaccination, à l'aide de la tomographie par émission de positrons au 18-fluorodésoxyglucose. (TEP 18-FDG). Résultats : Lorsqu'ils sont présents, les ganglions lymphatiques hypermétaboliques associés au vaccin COVID-19 présentent une valeur de captation standard maximale moyenne (SUV max) de 2,5 ± 0,3, et sont plus fréquents chez les jeunes patients. L'activité métabolique est la plus intense dans les deux premières semaines suivant la vaccination et diminue avec le temps. Au bout de 5 à 6 semaines environ, seule la moitié des patients présentait une captation appréciable et de faible intensité par rapport au bruit de fond. Conclusion : Sur la base de nos résultats préliminaires, nous recommandons une corrélation avec les antécédents et le moment de la vaccination et l'utilisation systématique d'un questionnaire préalable au patient pour guider l'interprétation afin d'éviter un surdiagnostic des métastases ganglionnaires axillaires et/ou des examens inutiles chez les patients oncologiques.

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COVID-19 vaccine-related lymph node activation – patterns of uptake on PET-CT

Cited by 12 publications

References 20 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

Vaccine-Related Lymph Nodes

Intensity of hypermetabolic axillary lymph nodes in oncologic patients in relation to timeline following COVID-19 vaccination

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