Examination of iatrogenic FDG accumulation after COVID-19 vaccination

Keiko Takahashi; Osamu Manabe; Kazuya Shizukuishi; Hirohumi Shibata; Hiroki Kawakami; Akira Otsuka; Noriko Oyama-Manabe

doi:10.1007/s12149-024-01909-5

Examination of iatrogenic FDG accumulation after COVID-19 vaccination

Ann Nucl Med. 2024 Apr 2. doi: 10.1007/s12149-024-01909-5. Online ahead of print.

Authors

Keiko Takahashi^{1

2}, Osamu Manabe³, Kazuya Shizukuishi⁴, Hirohumi Shibata⁴, Hiroki Kawakami⁵, Akira Otsuka⁵, Noriko Oyama-Manabe¹

Affiliations

¹ Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
² Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan.
³ Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan. omanabe@jichi.ac.jp.
⁴ Saitama Central Clinic, Saitama, Japan.
⁵ Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.

PMID: 38563890
DOI: 10.1007/s12149-024-01909-5

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.

Keywords: COVID-19; Fluorodeoxyglucose; Iatrogenic; Positron emission tomography; Vaccine.