Vaccination can cause transient inflammation of lymph nodes which demonstrates increased avidity through macrophage accumulation. Many inflammatory and reactive phenomena are known to cause false-positive avidity. Knowledge about potential false-positive results on PET-CT is vital to ensure accurate interpretation during reporting by taking into account the clinical context. No other avid lymph nodes were demonstrated elsewhere on the PET-CT and uptake within ipsilateral, morphologically normal appearing lymph nodes prompted the diagnosis of vaccine-induced adenopathy. Intense uptake was seen in normal-sized left axillary and pectoral lymph nodes with a normal fatty hilum. Patient had received first dose of COVID-19 vaccine 10 days prior to the FDG PET-CT.įDG PET-CT (MIP, axial PET only, fused PET-CT, CT only in lung and soft tissue windows, sagittal fused PET-CT and CT only) demonstrated intensely avid uptake in the right apex in keeping with a primary lung malignancy. Case 1Ī 77-year-old female was referred for FDG PET-CT for staging of a biopsy proven left upper lobe non-small cell lung cancer (adenocarcinoma)( Figure 1). We aim to present a pictorial review of this phenomenon in COVID-19 vaccinated individuals in order to ensure the imaging community is aware of this pitfall during the current vaccination drive. 6–10 To our knowledge, spectrum and patterns of local sites of uptake post COVID-19 vaccination as seen on FDG PET-CT in case review format have not been reported. 5 Several case reports of lymphadenopathy post COVID-19 vaccination have been published recently. Vaccinations and injections are known to cause diagnostic dilemma due to false-positive uptake locally on FDG PET-CT. It is important for the reporting Nuclear Medicine physician and Radiologist to accurately interpret and recognise potential imaging challenges and pitfalls of false-positive FDG avidity. It has major roles in oncology for staging and post-treatment follow up of many cancers. Whole-body 18 F-2-fluoro-2-deoxy- d-glucose positron emission tomography with low-dose CT (FDG PET/CT) combines functional and anatomical imaging. UK vaccination drive began on the 8 December 2020 and vaccines are currently offered to frontline health and social care workers, care home residents and staff, people with chronic conditions including patients on chemotherapy and older adults. 2 Mass vaccination is considered the main solution to this crisis. 1 Many countries including the UK have resorted to ‘national lockdown: stay at home’ measures to curb the spread of disease. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the novel coronavirus disease (COVID-19), a global pandemic. Knowledge about these patterns of uptake on PET-CT will ensure accurate interpretation by Nuclear Medicine physicians and radiologists during the current vaccination drive. All patients undergoing FDG PET-CT will require detailed documentation of the vaccination history including the time interval since vaccination. In this pictorial case review, we present five cases demonstrating various patterns of uptake including an ipsilateral deltoid muscle, axillary, supraclavicular, and subpectoral lymph nodes post COVID-19 vaccination.Ī careful history of COVID-19 vaccination and normal size and morphology of lymph node on unenhanced low-dose CT will aid the diagnosis. Various vaccinations and local injections have been known to cause diagnostic dilemma due to false-positive uptake on FDG PET-CT. Immunization can cause transient inflammation thereby causing increased metabolic activity at injection site and hypermetabolic lymph nodes. In a bid to end the current COVID-19 crisis, many countries including UK have begun a mass immunization programme.
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