Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
Institute of Oncology, Tel-Aviv Sourasky Medical Center, 6 Weizmann St, 6423906, Tel Aviv, Israel.
Eur J Nucl Med Mol Imaging. 2022 Mar;49(4):1338-1344. doi: 10.1007/s00259-021-05579-7. Epub 2021 Oct 15.
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 [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 [F]FDG PET-CT interpretation in oncologic patients.
A total of 179 consecutive oncologic patients that underwent [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.
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).
VAHL is commonly identified on [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.
在接种第一剂和第二剂 BNT162b2 疫苗后，COVID-19 疫苗相关高代谢性淋巴结病（VAHL）的发生率很高。已经报道了这种发现对 [F]FDG PET-CT 解释的影响及其与诱导的体液免疫的相关性。假设在接种第三剂疫苗后，记忆性免疫反应不同，我们旨在探讨接种第三剂 BNT162b2 疫苗后随时间推移 VAHL 的发生率，及其与肿瘤患者 [F]FDG PET-CT 解释的相关性。
共纳入 179 例连续接受第三剂 BNT162b2 疫苗后行 [F]FDG PET-CT 的肿瘤患者。评估 VAHL 的存在。在 VAHL 阳性扫描中，记录 SUVmax、“热”结节的数量、位置和大小。接种和影像学之间的中位时间间隔为 8（IQR，5-14）天。
所有等级 VAHL 和 3-4 级 VAHL 的发生率分别为 47.5%和 8.9%。在接种后 5 天内进行的 82.5%的研究中发现了 VAHL。在接种后 5 天内进行的 28.1%的研究中观察到 3-4 级 VAHL，但在接种后超过 5 天进行的研究中未检测到。在 179 例研究患者中，仅 2 例无法区分 VAHL 与恶性淋巴结病。在多变量逻辑回归中，3-4 级 VAHL 的独立预测因素为接种和影像学之间的时间间隔短（Pv<0.01）、年龄较小（Pv<0.01）和 BMI 较低（Pv=0.03）。
在接种第三剂 BNT162b2 疫苗后 5 天内进行的 [F]FDG PET-CT 中，VAHL 通常被识别。在接种后 6 天或更长时间进行的扫描中不太可能观察到高级 VAHL，在年龄较大和肥胖患者中甚至更不可能。
