Medical imaging in times of pandemic: focus on the cornerstones of successful imaging

Delgado-Bolton, Roberto; Terán, Adriana K. Calapaquí; Erba, Paola Anna; Giammarile, Francesco

doi:10.1007/s00259-021-05331-1

Cited by 11 publications

(9 citation statements)

References 11 publications

(11 reference statements)

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“…During the SARS-CoV-2 pandemic several 2-[ 18 F]FDG PET/CT imaging findings associated with COVID-19 were described [ 19 , 20 , 21 ]. Further 2-[ 18 F]FDG PET/CT findings were described after the introduction of COVID-19 vaccines [ 5 , 6 , 9 ], in particular HALNs ipsilateral to the vaccine injection site.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Significance of Hypermetabolic Lymph Nodes Detected by 2-[18F]FDG PET/CT after COVID-19 Vaccination: A Systematic Review and a Meta-Analysis

et al. 2021

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Recently, several articles reported incidental findings at 2-[18F]FDG PET/CT in patients who have received COVID-19 vaccinations, including hypermetabolic axillary lymph nodes (HALNs) ipsilateral to the COVID-19 vaccine injection site which may cause diagnostic dilemmas. The aim of our work was to calculate the prevalence of this finding. A comprehensive computer literature search of PubMed/MEDLINE, Embase, and Cochrane library databases was performed to identify recently published articles that investigated the prevalence of HALNs detected by 2-[18F]FDG PET/CT after COVID-19 vaccination. Pooled prevalence of this finding was calculated through a meta-analytic approach. Nine recently published articles including 2354 patients undergoing 2-[18F]FDG PET/CT after recent COVID-19 vaccination have been included in the systematic review. Overall, HALNs ipsilateral to the vaccine injection site were frequent findings mainly due to vaccine-related immune response in most of the cases. The pooled prevalence of HALNs after COVID-19 vaccination was 37% (95% confidence interval: 27–47%) but with significant heterogeneity among the included studies. Physicians must be aware and recognize the significant frequency of HALNs at 2-[18F]FDG PET/CT related to immune response to vaccine injection. Larger studies are needed to confirm the findings of this systematic review and meta-analysis.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Significance of Hypermetabolic Lymph Nodes Detected by 2-[18F]FDG PET/CT after COVID-19 Vaccination: A Systematic Review and a Meta-Analysis

et al. 2021

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“…Around one dozen articles review the phenomenon and updated clinical guidelines. 15 , 17 , 19 , 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 31 , 32 , 33 , 34 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ,…”

Section: Discussion With Review Of Literatureunclassified

COVID-19 vaccine-related axillary lymphadenopathy in breast cancer patients: Case series with a review of literature

Lim

Lee

Khil

et al. 2021

Seminars in Oncology

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Purpose – Lymphadenopathy (LAP) after COVID-19 vaccination in patients with a diagnosis of cancer has been challenging. We analyzed imaging and clinical features from early cases of axillary LAP in six COVID-19 vaccine recipients with a history of breast cancer. Method – Among the patients with a history of breast cancer and recent COVID-19 vaccine administration, six patients who showed isolated axillary LAP were gathered. Radiologic features were reviewed from breast ultrasound, chest computed tomography, and breast magnetic resonance imaging. Clinical and pathological information were obtained for analysis. Results – The interval between ultrasound detection of LAP and last COVID-19 vaccine administration ranged from 14 to 28 days (mean 21.67 days). Round shape of the lymph node and irregular cortex were noted in two and zero cases, respectively. Mean maximum cortical thickness, length to width ratio and interval aggravation in maximum cortical thickening were 4.2 mm, 1.34 and 2.81-fold with cut-off value of 3 mm, 1.5, 2.0-fold, respectively. Conclusion – We observed axillary LAP ipsilateral to a recent vaccine administration persisting longer than what the Centers for Disease Control and Prevention announced. In our patients, COVID-19 vaccine related LAP tended to show increased cortical thickness without cortical irregularity. Oncologist as well as radiologist should be familiar with the fact that COVID-19 vaccines, regardless of vaccine type or dosage, can frequently cause ipsilateral axillary LAP, showing some suspicious features more often than others, and can persist longer than anticipated so that both over- and underdiagnosis can be avoided. We report our observations in six patients and provide an exhaustive review of the published literature

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“…The frequent appearance of VAHL on [ 18 F]FDG PET-CT studies in recently vaccinated oncologic patients has become a major concern in the era of the COVID-19 pandemic [8,[11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…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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Medical imaging in times of pandemic: focus on the cornerstones of successful imaging

Cited by 11 publications

References 11 publications

Prevalence and Significance of Hypermetabolic Lymph Nodes Detected by 2-[18F]FDG PET/CT after COVID-19 Vaccination: A Systematic Review and a Meta-Analysis

Prevalence and Significance of Hypermetabolic Lymph Nodes Detected by 2-[18F]FDG PET/CT after COVID-19 Vaccination: A Systematic Review and a Meta-Analysis

COVID-19 vaccine-related axillary lymphadenopathy in breast cancer patients: Case series with a review of literature

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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