From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (S.M.H., S.Y.K., S.H.L., H.Y., N.C., W.K.M., J.M.C.); Department of Radiology, Seoul National College of Medicine, Seoul, Republic of Korea (S.M.H., S.Y.K., S.H.L., N.C., W.K.M., J.M.C.); Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea (A.J.C.); and Department of Clinical Epidemiology & Biostatistics, University of Ulsan College of Medicine, Seoul, Korea (J.B.L.).
Radiology. 2022 Oct;305(1):46-53. doi: 10.1148/radiol.220543. Epub 2022 Apr 26.
Background Both temporal changes in imaging characteristics of lymphadenopathy on US scans after COVID-19 vaccination and expected duration of radiologically evident lymphadenopathy remain uncertain. Purpose To longitudinally evaluate COVID-19 vaccine-associated lymphadenopathy on axillary US scans at various time intervals in both messenger (mRNA) and vector vaccine recipients. Materials and Methods This prospective cohort study was conducted between March 2021 and January 2022. The participants were asymptomatic women without breast cancer who had received COVID-19 vaccination. Serial follow-up US was performed in women with lymphadenopathy. The following variables were assessed: cortical thickness, number of lymph nodes, morphologic characteristics, and Doppler signal. Temporal changes in cortical thickness and number of lymph nodes during follow-up were assessed using a linear mixed model. Results Ninety-one women with lymphadenopathy in the vaccinated arm had undergone a total of 215 serial US examinations (mean age, 44 years ± 13 [SD]). Fifty-one participants had received a vector vaccine (ChAdOx1 nCoV-19 vaccine) and 40 had received an mRNA vaccine (BNT162b2 vaccine [ = 37] and mRNA-1273 vaccine [ = 3]). Three of the 91 women were lost to follow-up; thus, 88 women underwent serial US. Complete resolution of axillary lymphadenopathy was observed at a median of 6 weeks after vaccination (range, 4-7 weeks) in 26% of women (23 of 88). Among 49 women with follow-up US at a median of 12 weeks after vaccination (range, 8-14 weeks), persistent lymphadenopathy was observed in 25 (51%). During the follow-up period, the cortical thickness gradually decreased ( < .001) over time regardless of vaccine type; however, values were higher in recipients of the mRNA vaccine than in recipients of the vector vaccine ( = .02). Conclusion COVID-19 vaccine-associated axillary lymphadenopathy frequently persisted for more than 6 weeks on US scans. Lymphadenopathy should be interpreted considering vaccine type and time elapsed since vaccination. Follow-up US examination at least 12 weeks after vaccination may be reasonable, particularly for recipients of the messenger RNA vaccine. © RSNA, 2022 See also the editorial by Moy and Kim in this issue.
背景 新冠肺炎 (COVID-19) 疫苗接种后淋巴结超声扫描的影像学特征的时间变化以及放射学上明显淋巴结肿大的预期持续时间仍不确定。
目的 旨在在信使 (mRNA) 和载体疫苗接种者中，在不同时间间隔对腋窝超声扫描的 COVID-19 疫苗相关淋巴结病进行纵向评估。
材料与方法 本前瞻性队列研究于 2021 年 3 月至 2022 年 1 月进行。参与者为无症状、无乳腺癌的女性，已接种 COVID-19 疫苗。对有淋巴结病的女性进行连续的超声随访。评估了以下变量：皮质厚度、淋巴结数量、形态特征和多普勒信号。使用线性混合模型评估随访过程中皮质厚度和淋巴结数量的时间变化。
结果 在接种疫苗的手臂中，91 名淋巴结病患者共进行了 215 次连续超声检查（平均年龄 44 岁±13[SD]）。51 名参与者接种了载体疫苗（ChAdOx1 nCoV-19 疫苗），40 名参与者接种了 mRNA 疫苗（BNT162b2 疫苗[=37]和 mRNA-1273 疫苗[=3]）。91 名女性中有 3 名失访；因此，88 名女性进行了连续超声检查。接种疫苗后中位 6 周（范围 4-7 周）时，26%（23/88）的女性完全缓解腋窝淋巴结病。在接种疫苗后中位 12 周（范围 8-14 周）进行了超声随访的 49 名女性中，25 名（51%）仍有淋巴结病。在随访期间，无论疫苗类型如何，皮质厚度随时间逐渐降低（<.001）；然而，mRNA 疫苗接种者的皮质厚度高于载体疫苗接种者（=.02）。
结论 COVID-19 疫苗相关腋窝淋巴结病在超声扫描上常持续超过 6 周。应考虑疫苗类型和接种疫苗后时间来解释淋巴结病。接种疫苗后至少 12 周进行超声随访可能是合理的，特别是对于信使 RNA 疫苗接种者。
© RSNA，2022 本期亦见 Moy 和 Kim 的社论。
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