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

Treglia, Giorgio; Cuzzocrea, Marco; Giovanella, Luca; Elzi, Luigia; Muoio, Barbara

doi:10.3390/ph14080762

Cited by 32 publications

(39 citation statements)

References 37 publications

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“…The current study demonstrates that the overall incidence of any-grade VAHL following the third Covid-19 vaccine dose is basically similar to that reported following the rst and second Covid-19 vaccine doses [8][9][10][14][15][16]. However, VAHL cases following the third dose were found to have shorter duration andlow uptake intensity after the rst 5 days from vaccination.…”

Section: Discussionsupporting

confidence: 76%

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A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

Preprint

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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 [18F]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 [18F]FDGPET-CT interpretation in oncologic patients.Methods: A total of 179 consecutive oncologic patients that underwent [18F]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 imagingwas 8 (IQR,5-14) days.Results: The 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 identifiedon [18F]FDG PET-CT performed within the first 5 days from the third BNT162b2 vaccine doseadministration. 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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Section: Discussionsupporting

confidence: 76%

“…The characteristics of VAHL following the rst and second vaccine doses were reported to be different [8,10,16]. This probably re ects the difference between the immune response elicited by a rst vaccine dose and the amnestic response induced by a booster given 3 weeks later.…”

Section: Discussionmentioning

confidence: 99%

A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

Preprint

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“…Interestingly, they also observed that Aβ 1-42 significantly increased SARS-CoV-2 infectivity and that the clearance of Aβ 1-42 can be reduced during SARS-CoV-2 infection [10]. Similar findings with other radiopharmaceuticals were recently described [7][8][9], but this is the first case to show that also [ 18 F]Florbetaben PET/CT can demonstrate immune-induced findings, also amplified by the beta-amyloid presence, associated with the current COVID-19 pandemic vaccination programs, being a potential finding on whole-body protocols for the assessment of cardiac/systemic amyloidosis.…”

Section: Case Presentationsupporting

confidence: 77%

“…We assume that the subcutaneous and the potential lymph node uptake might be related to an induced inflammation with peptides deposition, as amyloid-beta peptides are involved in the systemic inflammatory process such as in the physiopathology of AD, and chronic, low-level systemic inflammation may exacerbate the Aβ deposition [3][4][5][6]. Such induced inflammation, already demonstrated with several tracers [7][8][9], may be further enhanced in AD patients by the amyloid-beta presence. In this sense, Hsu et al observed in a preclinical study that the intracellular immunoreactivity was significantly increased by the SARS-CoV-2 pseudovirus in the presence of Aβ 1-42 (a strong indicator of AD with high affinity for SARS-CoV-2 spike protein S1 subunit) compared to SARS-CoV-2 pseudovirus alone.…”

Section: Case Presentationmentioning

confidence: 87%

Subcutaneous Uptake on [18F]Florbetaben PET/CT: a Case Report of Possible Amyloid-Beta Immune-Reactivity After COVID-19 Vaccination

Laudicella

Burger

Panasiti

et al. 2021

SN Compr. Clin. Med.

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Introduction Large-scale worldwide COVID-19 vaccination programs are being rapidly deployed, and high-risk patients with comorbidity are now receiving the first doses of the vaccine. Physicians should be, therefore, aware of new pitfalls associated with the current pandemic vaccination program, also in the case of [18F]Florbetaben PET/CT. Case Presentation We described the first image of [18F]Florbetaben PET/CT in the evaluation of a 70-year-old male with suspicious Alzheimer disease and unclear history of heart disease. We detailed the diagnostic imaging PET/CT workup with different findings. Conclusion In this case, [18F]Florbetaben PET/CT can demonstrate potential beta-amyloid immune-reactivity and deposition associated with the current COVID-19 pandemic vaccination programs.

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“…VAHL, vaccine-associated hypermetabolic lymphadenopathy; BMI, body mass index. Active malignancy, this variable was considered positive in cases of treatment-naïve patients, those who received recent anti-cancer therapy, and those with recurrent disease identified on their [ 18 [14][15][16]. However, VAHL cases following the third dose were found to have shorter duration and low uptake intensity after the first 5 days from vaccination.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 32 publications

References 37 publications

A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

A Sigh of Relief: Vaccine-Associated Hypermetabolic Iymphadenopathy 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

Subcutaneous Uptake on [18F]Florbetaben PET/CT: a Case Report of Possible Amyloid-Beta Immune-Reactivity After COVID-19 Vaccination

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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