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European Journal of Nuclear Medicine and Molecular Imaging

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01-03-2022 | COVID-19 Vaccination | Original Article

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

Authors: Dan Cohen, Shir Hazut Krauthammer, Ido Wolf, Einat Even-Sapir

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2022

Abstract

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]FDG PET-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 imaging was 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 identified on [¹⁸F]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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Title: 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
Authors: Dan Cohen
Shir Hazut Krauthammer
Ido Wolf
Einat Even-Sapir
Publication date: 01-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: COVID-19 Vaccination
Vaccination
COVID-19
Lymphadenopathy
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2022
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-021-05579-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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