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Review
. 2021 Aug;300(2):E323-E327.
doi: 10.1148/radiol.2021210436. Epub 2021 Feb 24.

Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel

Affiliations
Review

Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Radiology Scientific Expert Panel

Anton S Becker et al. Radiology. 2021 Aug.

Abstract

Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (eg, for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information-date(s) administered, injection site(s), laterality, and type of vaccine-should be included in every preimaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams, and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination.

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Figures

Example of vaccine-associated adenopathy in a 41-year-old female patient undergoing breast MRI for follow up of focal lesion. (a) T2-weighted fat-saturated axial slice through the breasts and anterior chest, within 5 days of receiving COVID-19 vaccination in the left shoulder showing asymmetric left axillary adenopathy (3.0 x 1.7 cm, arrowhead) with preserved fatty hilum but irregular cortex. (b) 6-week follow-up axillary sonography of the same patient demonstrates decreased size (2.2 x 1.1 cm) and some residual cortical thickening.
Figure 1:
Example of vaccine-associated adenopathy in a 41-year-old female patient undergoing breast MRI for follow up of focal lesion. (a) T2-weighted fat-saturated axial slice through the breasts and anterior chest, within 5 days of receiving COVID-19 vaccination in the left shoulder showing asymmetric left axillary adenopathy (3.0 x 1.7 cm, arrowhead) with preserved fatty hilum but irregular cortex. (b) 6-week follow-up axillary sonography of the same patient demonstrates decreased size (2.2 x 1.1 cm) and some residual cortical thickening.
Example of a 60-year-old male patient on surveillance for smoldering myeloma with typical vaccination-associated findings. (a) Coronal maximum intensity projection (MIP) of 18F-FDG-PET and (b) fused axial 18F-FDG-PET/CT showing FDG avidity in the left deltoid muscle (SUVmax 5.9 g/ml) from the injection site (arrowhead) and ipsilateral reactive FDG-avid draining axillary lymph nodes (SUVmax 9.6 g/ml) (arrow), which are normal-sized on CT.
Figure 2:
Example of a 60-year-old male patient on surveillance for smoldering myeloma with typical vaccination-associated findings. (a) Coronal maximum intensity projection (MIP) of 18F-FDG-PET and (b) fused axial 18F-FDG-PET/CT showing FDG avidity in the left deltoid muscle (SUVmax 5.9 g/ml) from the injection site (arrowhead) and ipsilateral reactive FDG-avid draining axillary lymph nodes (SUVmax 9.6 g/ml) (arrow), which are normal-sized on CT.

Comment in

References

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