COVID-19 vaccine is here: practical considerations for clinical imaging applications

Katal, Sanaz; Pouraryan, Arshia A.; Gholamrezanezhad, Ali

doi:10.1016/j.clinimag.2021.01.023

Cited by 19 publications

(23 citation statements)

References 35 publications

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“…In radiology and nuclear medicine, enhanced tracer uptake in reactive lymph nodes after any vaccination is a potential differential diagnosis in PET/CT scans [51][52][53][54][55][56][57][58] and is also emerging for COVID-19 vaccines [59][60][61][62][63][64][65][66]. However, there is little information on cytopathological findings.…”

Section: Discussionmentioning

confidence: 99%

Fine needle aspiration in COVID-19 vaccine-associated lymphadenopathy

et al. 2021

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AIMS: With ongoing intensive vaccination programme against COVID-19, numerous cases of adverse reactions occur, some of which represent rare events. Enlargement of the injection site's draining lymph nodes is increasingly reported, but is not yet widely recognised as being possibly associated with recent vaccination. As patients at risk of a severe course of COVID-19, indicated by their medical history such as a previous diagnosis of malignancy, receive priority vaccination, newly palpable lymph nodes raise concerns of disease progression. In this case series, we report on five patients who presented with enlarged lymph nodes after COVID-19 vaccination.METHODS: Sonography guided fine needle aspiration (FNA) was performed in five patients presenting with PETpositive and/or enlarged lymph nodes after COVID-19 vaccination with either the Pfizer-BioNTech or Moderna vaccine.RESULTS: COVID-19 vaccination had been carried out in all cases, with an interval of between 3 and 33 days prior to FNA. Three of five patients had a history of neoplasms. The vaccine was administered into the deltoid muscle, with subsequent enlargement of either the cervical, supra-, infra-or retroclavicular, or axillary lymph nodes, in four out of five cases ipsilaterally. In all cases, cytology and additional analyses showed a reactive lymphadenopathy without any sign of malignancy.CONCLUSIONS: Evidence of newly enlarged lymph nodes after recent COVID-19 vaccination should be considered reactive in the first instance, occurring owing to stimulation of the immune system. A clinical follow-up according to the patient's risk profile without further diagnostic measures is justified. In the case of preexisting unilateral cancer, vaccination should be given contralaterally whenever possible. Persistently enlarged lymph nodes should be re-evaluated (2 to) 6 weeks after the second dose, with additional diagnostic tests tailored to the clinical context. Fine needle aspiration is a well established, safe, rapid and cost-effective method to investigate an underlying malignancy, especially metastasis. Recording vaccination history, including date of injection, site and vaccine type, as well as communicating this information to treating physicians of different specialties is paramount for properly handling COVID-19 vaccine-associated lymphadenopathy.

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Section: Discussionmentioning

confidence: 99%

Fine needle aspiration in COVID-19 vaccine-associated lymphadenopathy

et al. 2021

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“…Similar to 18 F-FDG, radiopharmaceutical uptake in reactive lymph nodes has been already widely described with PET using radiolabelled choline [25] or somatostatin analogues [26]. Moreover, increased 18 F-FDG uptake in hypermetabolic lymph nodes due to vaccine-related immune response has been already described in several patients who underwent different types of vaccinations beyond those against COVID-19 [22], therefore this is not a significant novelty.…”

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confidence: 89%

“…On the other hand, these findings are not surprising for the nuclear medicine physicians for several reasons [22,23]. First of all, it is well known that inflammatory cells may take up 18 F-FDG due to their increased glucose uptake and glycolytic activity.…”

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confidence: 95%

PET findings after COVID-19 vaccination: “Keep Calm and Carry On”

Treglia

Cuzzocrea

Muoio

et al. 2021

Clin Transl Imaging

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“…Vaccinations and injections are known to cause diagnostic dilemma due to false-positive uptake locally on FDG PET-CT. 5 Several case reports of lymphadenopathy post COVID-19 vaccination have been published recently. 6–10 To our knowledge, spectrum and patterns of local sites of uptake post COVID-19 vaccination as seen on FDG PET-CT in case review format have not been reported.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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In a bid to end the current COVID-19 crisis, many countries including UK have begun a mass immunization programme. Immunization can cause transient inflammation thereby causing increased metabolic activity at injection site and hypermetabolic lymph nodes. Various vaccinations and local injections have been known to cause diagnostic dilemma due to false-positive uptake on FDG PET-CT. In this pictorial case review, we present five cases demonstrating various patterns of uptake including an ipsilateral deltoid muscle, axillary, supraclavicular, and subpectoral lymph nodes post COVID-19 vaccination. A careful history of COVID-19 vaccination and normal size and morphology of lymph node on unenhanced low-dose CT will aid the diagnosis. All patients undergoing FDG PET-CT will require detailed documentation of the vaccination history including the time interval since vaccination. Knowledge about these patterns of uptake on PET-CT will ensure accurate interpretation by Nuclear Medicine physicians and radiologists during the current vaccination drive.

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COVID-19 vaccine is here: practical considerations for clinical imaging applications

Cited by 19 publications

References 35 publications

Fine needle aspiration in COVID-19 vaccine-associated lymphadenopathy

Fine needle aspiration in COVID-19 vaccine-associated lymphadenopathy

PET findings after COVID-19 vaccination: “Keep Calm and Carry On”

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

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