COVID-19 Vaccine–Related Local FDG Uptake

Doss, Mohan; Nakhoda, Shazia; Li, Yang; Yu, Jinpu

doi:10.1097/rlu.0000000000003634

Cited by 19 publications

(25 citation statements)

References 7 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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“…With rapid and widespread rollout of the mRNA COVID-19 vaccinations [BNT162b2 (Pfizer-BioNTech vaccine) and mRNA-1273 (Moderna vaccine)], transient increased 2-deoxy-2[ 18 F]fluoro-D-glucose (FDG) uptake in normal or enlarged ipsilateral axillary, supraclavicular, and cervical lymph nodes after vaccination has been reported in patients undergoing positron emission tomography (PET) examinations [ 1 , 2 ]. This vaccine-induced lymphadenopathy may create FDG PET/CT interpretation challenges, particularly in cancer patients, affecting assessment of cancer staging and treatment response.…”

Section: Introductionmentioning

confidence: 99%

Temporal metabolic response to mRNA COVID-19 vaccinations in oncology patients

et al. 2021

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Background mRNA COVID-19 vaccines are known to provide an immune response seen on FDG PET studies. However, the time course of this metabolic response is unknown. We here present a temporal metabolic response to mRNA COVID-19 vaccination in oncology patients undergoing standard of care FDG PET. Methods 262 oncology patients undergoing standard of care FDG PET were included in the analysis. 231 patients had at least one dose of mRNA COVID-19 vaccine while 31 patients had not been vaccinated. The SUVmax of the lymph nodes ipsilateral to the vaccination was compared to the contralateral to obtain an absolute change in SUVmax (ΔSUVmax). Results ΔSUVmax was more significant at shorter times between FDG PET imaging and COVID-19 mRNA vaccination, with a median ΔSUVmax of 2.6 (0–7 days), 0.8 (8–14 days), and 0.3 (> 14 days), respectively. Conclusion Consideration should be given to performing FDG PET at least 2 weeks after the COVID-19 vaccine.

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“…Reports are rising of patients with unilateral axillary lymphadenopathies after Covid-19 vaccination highly uptaking at FDG-PET/CT scans [1][2][3][4][5][6][7][8][9].…”

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confidence: 99%

“…Indeed, at a further inspection of FDG PET/CT images, a triangular intramuscular FDG uptake in the left arm was also observed, corresponding to the injection site. As the second dose vaccine administration was performed in the time interval between CTCA/CMR and PET/CT in the ipsilateral arm, and the enlargement of the left axillary lymph node was more prominent in the PET/CT scan compared to CTCA, this finding was interpreted as indicative of inflammatory reaction [1][2][3][4][5][6][7][8][9]. However, to further disclose the ilo-mediastinal lymphadenopathies' underlying nature, EBUS-TBNA was performed on stations 4R and 11R.…”

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confidence: 99%