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Adin ME, Isufi E, Wu J, Pang Y, Nguyen D, Simsek Has D, Caner C, Aboueldaha N, Mossa-Basha M, Pucar D. Reactive axillary lymph nodes after COVID-19 mRNA vaccination: comparison of mRNA vs. attenuated whole-virus vaccines. Nucl Med Commun 2024; 45:474-480. [PMID: 38465449 DOI: 10.1097/mnm.0000000000001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE To compare the incidence and natural course of reactive axillary lymph nodes (RAL) between mRNA and attenuated whole-virus vaccines using Deauville criteria. METHODS In this multi-institutional PET-CT study comprising multiple vaccine types (Pfizer-BioNTech/Comirnaty, Moderna/Spikevax, Sinovac/CoronaVac and Janssen vaccines), we evaluated the incidence and natural course of RAL in a large cohort of oncological patients utilizing a standardized Deauville scaling system (n=522; 293 Female, Deauville 3-5 positive for RAL). Univariate and multivariate analyses were conducted to evaluate the predictive value of clinical parameters (absolute neutrophil count [ANC], platelets, age, sex, tumor type, and vaccine-to-PET interval) for PET positivity. RESULTS Pfizer-BioNTech/Comirnaty and Moderna vaccines revealed similar RAL incidences for the first 20 days after the second dose of vaccine administration (44% for the first 10 days for both groups, 26% vs. 20% for 10-20 days, respectively for Moderna and Pfizer). However, Moderna recipients revealed significantly higher incidences of RAL after 20 days compared to Pfizer-BioNTech/Comirnaty, with nodal reactivity spanning up to the 9th week post-vaccination (15% vs. 4%, respectively P < 0.001). No RAL was observed in patients who received either a single dose of J&J vaccine or two doses of CroronaVac. Younger patients showed increased likelihood of RAL, otherwise, clinical/demographic parameters were not predictive of RAL ( P = 0.014 for age, P > 0.05 for additional clinical/demographic parameters). CONCLUSION RAL based on strict PET criteria was observed with mRNA but not with attenuated whole-virus vaccines, in line with higher immunogenicity and stronger protection offered by mRNA vaccines.
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Affiliation(s)
- Mehmet Emin Adin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut,
| | - Edvin Isufi
- Departments of Radiology, University of Missouri, Columbia, Missouri
| | - Jennifer Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut,
| | - Yulei Pang
- Department of Mathematics, Southern Connecticut State University, New Haven, Connecticut,
| | - Daniel Nguyen
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Duygu Simsek Has
- Department of Nuclear Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Civan Caner
- Department of Nuclear Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Noha Aboueldaha
- Department of Radiology, Washington University School of Medicine, Seattle, Washington and
| | - Mahmud Mossa-Basha
- Department of Radiology, Washington University School of Medicine, Seattle, Washington and
| | - Darko Pucar
- Departments of Radiology, Cleveland Clinic, Weston, Florida, USA
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Takahashi K, Manabe O, Shizukuishi K, Shibata H, Kawakami H, Otsuka A, Oyama-Manabe N. Examination of iatrogenic FDG accumulation after COVID-19 vaccination. Ann Nucl Med 2024; 38:409-417. [PMID: 38563890 DOI: 10.1007/s12149-024-01909-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/23/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This study aimed to investigate the frequency of COVID-19 vaccine-induced reactive change and potential factors including blood type correlated with increased FDG uptake on positron emission tomography (PET)/computed tomography (CT). MATERIALS AND METHODS We evaluated 284 patients who underwent PET/CT between June and September 2021 and had a known history of COVID-19 vaccination. Information on the injection site, vaccine type, and adverse reactions was obtained. We visually assessed the presence or absence of accumulation in the axillary and supraclavicular lymph nodes and the deltoid muscles. We measured the maximum standardized uptake value (SUVmax) using semi-quantitative analysis. RESULTS Our study included 158 males and 126 females aged 16-94. The median time between vaccination and PET/CT was 9 and 42 days for patients who had received their first and second doses, respectively. We observed axillary lymph node accumulation, supraclavicular lymph node accumulation, and deltoid muscle accumulation in 98 (SUVmax 1.07-25.1), nine (SUVmax 2.28-14.5), and 33 cases (SUVmax 0.93-7.42), respectively. In cases with axillary lymph node (P = 0.0057) or deltoid muscle (P = 0.047) accumulation, the shorter the time since vaccination, the higher the FDG accumulation. Patients with axillary lymph node accumulation were significantly younger (P < 0.0001) and had a significantly higher frequency of adverse reactions such as fever (P < 0.0001) and myalgia (P = 0.002). No significant relationship was observed between blood type and the frequency of FDG accumulation. Logistic regression analysis also showed that age, gender, days since vaccination, and adverse reactions such as fever and myalgia were important factors for axillary lymph node accumulation. CONCLUSION Our study found that FDG accumulation in the axillary lymph nodes and deltoid muscle was higher within a shorter time after vaccination, and axillary lymph node accumulation was higher in young patients, females, and those with adverse reactions of fever and myalgia. No significant relationship was observed between blood type and the frequency of FDG accumulation. Confirming the vaccination status, time since vaccination, and the presence of adverse reactions before PET may reduce false positives.
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Affiliation(s)
- Keiko Takahashi
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | | | | | - Hiroki Kawakami
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akira Otsuka
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
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Anderson TM, Chang BH, Huang AC, Xu X, Yoon D, Shang CG, Mick R, Schubert E, McGettigan S, Kreider K, Xu W, Wherry EJ, Schuchter LM, Amaravadi RK, Mitchell TC, Farwell MD. FDG PET/CT Imaging 1 Week after a Single Dose of Pembrolizumab Predicts Treatment Response in Patients with Advanced Melanoma. Clin Cancer Res 2024; 30:1758-1767. [PMID: 38263597 PMCID: PMC11062839 DOI: 10.1158/1078-0432.ccr-23-2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/31/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE Immunologic response to anti-programmed cell death protein 1 (PD-1) therapy can occur rapidly with T-cell responses detectable in as little as one week. Given that activated immune cells are FDG avid, we hypothesized that an early FDG PET/CT obtained approximately 1 week after starting pembrolizumab could be used to visualize a metabolic flare (MF), with increased tumor FDG activity due to infiltration by activated immune cells, or a metabolic response (MR), due to tumor cell death, that would predict response. PATIENTS AND METHODS Nineteen patients with advanced melanoma scheduled to receive pembrolizumab were prospectively enrolled. FDG PET/CT imaging was performed at baseline and approximately 1 week after starting treatment. FDG PET/CT scans were evaluated for changes in maximum standardized uptake value (SUVmax) and thresholds were identified by ROC analysis; MF was defined as >70% increase in tumor SUVmax, and MR as >30% decrease in tumor SUVmax. RESULTS An MF or MR was identified in 6 of 11 (55%) responders and 0 of 8 (0%) nonresponders, with an objective response rate (ORR) of 100% in the MF-MR group and an ORR of 38% in the stable metabolism (SM) group. An MF or MR was associated with T-cell reinvigoration in the peripheral blood and immune infiltration in the tumor. Overall survival at 3 years was 83% in the MF-MR group and 62% in the SM group. Median progression-free survival (PFS) was >38 months (median not reached) in the MF-MR group and 2.8 months (95% confidence interval, 0.3-5.2) in the SM group (P = 0.017). CONCLUSIONS Early FDG PET/CT can identify metabolic changes in melanoma metastases that are potentially predictive of response to pembrolizumab and significantly correlated with PFS.
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Affiliation(s)
- Thomas M. Anderson
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bryan H. Chang
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alexander C. Huang
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parker Institute for Cancer Immunotherapy at University of Pennsylvania, Philadelphia, PA, USA
| | - Xiaowei Xu
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel Yoon
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Catherine G. Shang
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rosemarie Mick
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parker Institute for Cancer Immunotherapy at University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Erin Schubert
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Suzanne McGettigan
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin Kreider
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wei Xu
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E. John Wherry
- Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Parker Institute for Cancer Immunotherapy at University of Pennsylvania, Philadelphia, PA, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lynn M. Schuchter
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ravi K. Amaravadi
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tara C. Mitchell
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael D. Farwell
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Diaz-Menindez M, Sullivan MM, Wang B, Majithia V, Abril A, Butendieck RR, Ball CT, Berianu F. Dermatomyositis in Association With SARS-CoV-2 Infection or COVID-19 Vaccine. Arthritis Care Res (Hoboken) 2024; 76:98-104. [PMID: 37728071 DOI: 10.1002/acr.25236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE New-onset and relapsed dermatomyositis (DM) has been reported following SARS-CoV-2 infection or COVID-19 vaccination. This study aims to show the characteristics of a DM cohort after COVID-19 infection and vaccination. METHODS A retrospective review was performed on patients treated for DM between March 1, 2020, and October 31, 2022. Charts were evaluated for the presence of new-onset DM or relapse of preexisting DM following either SARS-CoV-2 infection or COVID-19 vaccination. Data on symptom onset, timing of vaccination, type of vaccination, and disease characteristics were collected. RESULTS Ninety-eight patients treated for DM at our institution in the Division of Rheumatology were included. In total, 12 of 98 patients (12.2%) experienced DM symptoms (either incident or relapse) following either infection or vaccination. Of the 12 patients who developed incident disease or relapse, 7 (58.3%) developed postinfection symptoms, and 8 (66.7%) developed symptoms after vaccination (3 patients had symptoms following both infection and vaccination). The mean onset of symptoms following COVID-19 infection was 3.2 days (median 0.5 days), and mean onset following COVID-19 vaccination was 5.75 days (median 3.5 days). Nine of 12 patients (75%) had a positive myositis-specific antibody, and the remaining 3 (25%) had myositis-associated antibodies. There was no predominant vaccine associated with the development of postvaccination DM symptoms. CONCLUSION This retrospective review revealed a strong temporal relationship between DM symptoms and COVID-19 infection or vaccination in 12.2% of all patients with DM evaluated in our clinic during the pandemic. Additional studies are required to understand the possible pathophysiology behind this association.
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Chiang MT, Wang JT, Lin WY, Yen RF, Huang JY, Lu CC. Comparison of post-COVID-19 vaccination hypermetabolic lymphadenopathy on 18F-fluorodeoxyglucose PET/CT between virus-vector vaccine and mRNA vaccine. Eur J Med Res 2023; 28:513. [PMID: 37964395 PMCID: PMC10647177 DOI: 10.1186/s40001-023-01456-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
PURPOSE We compared hypermetabolic lymphadenopathy (HLN) on 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) after virus-vector and mRNA vaccines for coronavirus disease 2019 (COVID-19). METHODS This retrospective study included 573 participants who underwent FDG PET/CT after receiving a virus-vector vaccine (ChAdOx1, AstraZeneca [AZ] group) or an mRNA vaccine (mRNA-1273, Moderna [M] group) from July 2021 to October 2021. The incidence and avidity of HLN were evaluated and correlated with clinical features and vaccine type. The final analysis was conducted with 263 participants in the AZ group and 310 participants in the M group. RESULTS The HLN incidence was significantly lower in the AZ group than in the M group (38/263 [14%] vs. 74/310 [24%], p = 0.006). The FDG avidity of HLN was comparable between the two groups. The HLN incidence in both groups was significantly higher within 4 weeks after the vaccination compared with more than 4 weeks. The HLN incidence within 4 weeks of the vaccination was significantly higher in the M group than in the AZ group (p = 0.008), whereas a difference in HLN incidence between the two groups was not observed after the same duration (p = 0.11). CONCLUSIONS The mRNA mRNA-1273 COVID-19 vaccine was found to be associated with higher glucose hypermetabolism in regional lymph nodes within the first 4 weeks compared with the virus-vector vaccine, as indicated by the presence of HLN on FDG PET/CT. The degree of glucose hypermetabolism was comparable between the two vaccines.
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Affiliation(s)
- Meng-Ting Chiang
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wan-Yu Lin
- Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan
| | - Jei-Yie Huang
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan
| | - Ching-Chu Lu
- Department of Nuclear Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City, Taiwan.
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CALABRIA FERDINANDO, BAGNATO ANTONIO, GUADAGNINO GIULIANA, TOTEDA MARIA, LANZILLOTTA ANTONIO, CARDEI STEFANIA, TAVOLARO ROSANNA, LEPORACE MARIO. COVID-19 vaccine related hypermetabolic lymph nodes on PET/CT: Implications of inflammatory findings in cancer imaging. Oncol Res 2023; 31:117-124. [PMID: 37304242 PMCID: PMC10207995 DOI: 10.32604/or.2023.027705] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/20/2023] [Indexed: 06/13/2023] Open
Abstract
We observed several patients presenting 2-[18F]FDG uptake in the reactive axillary lymph node at PET/CT imaging, ipsilateral to the site of the COVID-19 vaccine injection. Analog finding was documented at [18F]Choline PET/CT. The aim of our study was to describe this source of false positive cases. All patients examined by PET/CT were included in the study. Data concerning patient anamnesis, laterality, and time interval from recent COVID-19 vaccination were recorded. SUVmax was measured in all lymph nodes expressing tracer uptake after vaccination. Among 712 PET/CT scans with 2-[18F]FDG, 104 were submitted to vaccination; 89/104 patients (85%) presented axillary and/or deltoid tracer uptake, related to recent COVID-19 vaccine administration (median from injection: 11 days). The mean SUVmax of these findings was 2.1 (range 1.6-3.3). Among 89 patients with false positive axillary uptake, 36 subjects had received chemotherapy due to lymph node metastases from somatic cancer or lymphomas, prior to the scan: 6/36 patients with lymph node metastases showed no response to therapy or progression disease. The mean SUVmax value of lymph nodal localizations of somatic cancers/lymphomas after chemotherapy was 7.8. Only 1/31 prostate cancer patients examined by [18F]Choline PET/CT showed post-vaccine axillary lymph node uptake. These findings were not recorded at PET/CT scans with [18F]-6-FDOPA, [68Ga]Ga-DOTATOC, and [18F]-fluoride. Following COVID-19 mass vaccination, a significant percentage of patients examined by 2-[18F]FDG PET/CT presents axillary, reactive lymph node uptake. Anamnesis, low-dose CT, and ultrasonography facilitated correct diagnosis. Semi-quantitative assessment supported the visual analysis of PET/CT data; SUVmax values of metastatic lymph nodes were considerably higher than post-vaccine lymph nodes. [18F]Choline uptake in reactive lymph node after vaccination was confirmed. After the COVID-19 pandemic, nuclear physicians need to take these potential false positive cases into account in daily clinical practice.
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Affiliation(s)
- FERDINANDO CALABRIA
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - ANTONIO BAGNATO
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - GIULIANA GUADAGNINO
- Department of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, 87100, Italy
| | - MARIA TOTEDA
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - ANTONIO LANZILLOTTA
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - STEFANIA CARDEI
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - ROSANNA TAVOLARO
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
| | - MARIO LEPORACE
- Department of Nuclear Medicine and Theragnostics, Mariano Santo Hospital, Cosenza, 87100, Italy
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Elsakka A, Yeh R, Das J. The Clinical Utility of Molecular Imaging in COVID-19: An Update. Semin Nucl Med 2023; 53:98-106. [PMID: 36243572 PMCID: PMC9492514 DOI: 10.1053/j.semnuclmed.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 01/28/2023]
Abstract
The novel pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered in Wuhan, China in late 2019 with Coronavirus disease 2019 (COVID-19) declared a global pandemic in March 2020. Primarily involving the lungs, conventional imaging with chest radiography and CT can play a complementary role to RT-PCR in the initial diagnosis, and also in follow up of select patients. As a broader understanding of the multi-systemic nature of COVID-19 has evolved, a potential role for molecular imaging has developed, that may detect functional changes in advance of standard cross-sectional imaging. In this review, we highlight the evolving role of molecular imaging such as fluorine-18 (18F) fluorodeoxyglucose (FDG) with PET/CT and PET/MRI in the evaluation of both pulmonary and extra-pulmonary COVID-19, ventilation and perfusion scan with SPECT/CT for thromboembolic disease, long term follow-up of COVID-19 infection, and COVID-19 vaccine-related complications.
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Affiliation(s)
- Ahmed Elsakka
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY,Body Imaging Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY
| | - Randy Yeh
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Jeeban Das
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY,Body Imaging Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY
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Hypermetabolic Ipsilateral Supraclavicular and Axillary Lymphadenopathy: Optimal Time Point for Performing an 18F-FDG PET/CT after COVID-19 Vaccination. Diagnostics (Basel) 2022; 12:diagnostics12123073. [PMID: 36553080 PMCID: PMC9777490 DOI: 10.3390/diagnostics12123073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/02/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background: We aimed to evaluate the incidence of severe acute respiratory syndrome coronavirus type-2 (SARS-CoV2) vaccine-related hypermetabolic lymphadenopathy (HLA) and evaluate which time point produces the least number of false-positive findings in an 18F-2-Fluor-2-desoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT). Methods: For this retrospective, multi-center imaging study, patients with any form of SARS-CoV2 vaccination prior to an 18F-FDG-PET/CT were included between January 2021 and December 2021. Patients were divided into six groups according to the time point of vaccination prior to their 18F-FDG-PET/CT imaging, e.g., group one (0−6 days) and group six (35−80 days). As the reference standards, the SUVmax of the mediastinal blood pool (MBP) and the SUVmax contralateral reference lymph node (RL) were determined. (A) The absolute SUVmax of HLA, (B) the ratio of SUVmaxHLA/SUVmax mediastinal blood pool (rHLA/MBP), (C) the ratio SUVmax HLA vs. SUVmax contralateral reference lymph node (rHLA/RL), (D) and the incidence of HLA defined as rHLA/MBP > 1.5 were assessed. Results: Group one (days 0−6) showed the highest incidence of HLA 16/23 (70%) and rHLA/MBP (2.58 ± 2.1). All three parameters for HLA reduced statistically significantly in the comparison of Groups 1−3 (days 0−20) versus Groups 4−6 (days 21−80) (p-values < 0.001). Conclusions: If feasible, an FDG PET should be postponed by at least 3 weeks after SARS-CoV2 vaccination, especially if an accurate evaluation of axillary status is required.
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İşgören S, Köroğlu G, Görür GD, Demir H. Evaluation of metabolic changes in FDG PET/CT imaging after mRNA-based COVID-19 vaccination. Turk J Med Sci 2022; 52:1745-1753. [PMID: 36945983 PMCID: PMC10390183 DOI: 10.55730/1300-0144.5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It isimportant to evaluate the vaccine-related metabolic changes on FDG PET/CT to avoid confusing results. We here aimed to assess the frequency and intensity of regional and systemic metabolic PET/CT changes of patients who received the mRNAbased COVID-19 vaccine (BNT162b2-Pfizer/BioNTech) and to analyze possible factors affecting these changes. METHODS Among the patients who underwent FDG PET/CT for any indication in our department between July 2021 and December 2021, 129 volunteer patients with a history of COVID-19 vaccination were included in this prospective observational study. Bilateral axillary lymph nodes, ipsilateral deltoid muscle, bone marrow, spleen, thyroid, and liver FDG uptakes were evaluated visually and semiquantitatively for each examination. RESULTS The frequencies of positive axillary lymph nodes after vaccination were 40%, 44.4%, 32.6%, and 44.7% in all, 1st dose, 2nd dose, and heterologous vaccination regimens groups, respectively. Maximum standardized uptake values of spleen, liver, and bone marrow were statistically high in patients with positive axillary lymph nodes than with negative ones (p < 0.05). Positive deltoid muscle uptake and diffusely increased thyroid uptake findings were observed in 10 and 8 patients, respectively. The median time interval between vaccination and imaging was 9.5 days for patients with positive axillary lymph nodes and 17 days for patients with negative nodes. In our study group, only 8 patients had a positive documented history of COVID-19 infection. DISCUSSION Regional and systemic metabolic changes were occasionally found on FDG PET/CT imaging in patients who received the mRNA-based COVID-19 vaccine. To avoid these timely decreasing changes, we recommend managing the ideal timing of imaging or vaccination and taking a careful history.
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Affiliation(s)
- Serkan İşgören
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Gizem Köroğlu
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Gözde Dağlıöz Görür
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Hakan Demir
- Department of Nuclear Medicine Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Minamimoto R. Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data. Front Med (Lausanne) 2022; 9:1052921. [PMID: 36341267 PMCID: PMC9626818 DOI: 10.3389/fmed.2022.1052921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/07/2022] [Indexed: 09/07/2024] Open
Abstract
The COVID-19 pandemic has forced people to significantly change their lifestyles and attitudes, and has greatly burdened healthcare delivery systems worldwide. The redistribution of the medical delivery system to maintain normal medical care while responding generously to COVID-19 is a continuing challenge that weighs heavily on medical institutions. Among imaging modalities, chest X-rays and computed tomography (CT) examinations have clearly made a large contribution to treatment of COVID-19. In contrast, it is difficult to express the standpoint of nuclear medicine examinations in a straightforward manner, as the greatest emphasis in this modality has been on how necessary medical care can continue to be provided. Many clinical reports of nuclear medicine examinations related to COVID-19 have been published, and knowledge continues to accumulate. This review provides a summary of the current state of oncology and cardiology positron emission tomography (PET) examinations related to COVID-19, and includes preparation of the nuclear medicine department, trends in PET examinations, specific imaging findings on 18F-fluorodeoxyglucose (FDG) PET/CT, imaging of complications of COVID-19, PET tracers other than FDG, and the effects of vaccines on PET imaging findings.
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Affiliation(s)
- Ryogo Minamimoto
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
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Awaya T, Moroi M, Enomoto Y, Kunimasa T, Nakamura M. What Should We Do after the COVID-19 Vaccination? Vaccine-Associated Diseases and Precautionary Measures against Adverse Reactions. Vaccines (Basel) 2022; 10:vaccines10060866. [PMID: 35746474 PMCID: PMC9228524 DOI: 10.3390/vaccines10060866] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 01/01/2023] Open
Abstract
COVID-19 vaccines have been used to counteract the global COVID-19 pandemic. While these are effective, adverse reactions have been reported, such as injection-site pain, muscle ache, fever, palpitation, and chest discomfort. The release of inflammatory cytokines, such as interleukin (IL)-6 and IL-1β, is a potential mechanism for post-vaccine side-effects. Chest discomfort after the vaccination, including myocarditis and acute coronary syndrome, is a particularly serious adverse reaction. It is important to be familiar with the differential diagnoses of chest discomfort and organ-specific diseases associated with COVID-19 vaccines as the preparation for booster shots and vaccinations among children aged 5–11 years begins. High-intensity exercise, alcohol, tobacco smoking, and baths promote inflammatory cytokines, such as IL-6, which may exacerbate the adverse reactions after vaccination. Japanese data show that deaths during baths are the most common for several days after mRNA vaccination. Additionally, alcohol and tobacco smoking were identified as predictive factors of lower antibody titers after vaccination. In this review, we aimed to provide a few recommendations to prevent vaccine-associated disease.
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