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A 77-year-old man with a history of chronic lower back pain, and prior spinal fusion surgery X2 was referred for 99mTc-WBC Study for evaluation of worsening back pain and cervical radiculopathy to rule out any signs of infection. The patients white blood cells were tagged with 99mTc-HMPAO (hexamethylpropylene amine oxime), and planar and SPECT/CT imaging was performed at 4 and 24 hours. 99mTc-WBC Study showed no abnormal isotope localization in the spine; however, there was an incidental finding of bilateral increased soft tissue uptake in axillary lymph nodes. Medical history revealed intramuscular injection of second and third dose of Moderna mRNA COVID-19 vaccine in bilateral deltoids approximately 11 and 5 months before scan.

Intra-arterial injection of radioactive isotope 90-yttrium 90Y has been used for elective internal radiation therapy for the treatment of localized hepatocellular carcinoma deemed surgically unresectable. It has also been used to treat intrahepatic cholangiocarcinoma and colorectal cancer that has metastasized to the liver. To prepare for 90Y treatment, preprocedural mapping via hepatic angiography and 99mTc–macroaggregated albumin liver lung shunt study followed by postprocedural 90Y SPECT/CT is essential to ensure a targeted therapy. Therapy is contraindicated if lung shunt fraction is greater than 20% for SIR-Spheres. Anatomic variation in hepatic angiography may be present that can lead to complications if unaccounted for.