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. 2022 Nov;63(11):1673-1676.
doi: 10.2967/jnumed.121.263758. Epub 2022 Mar 3.

Temporary Reactive Response of Axillary Lymph Nodes to COVID-19 Vaccination on 18F-rhPSMA-7.3 PET/CT in Patients with Prostate Cancer

Susan Notohamiprodjo  1 , Matthias Eiber  2 , Christian Lohrmann  2 , Wolfgang A Weber  2
Affiliations

Temporary Reactive Response of Axillary Lymph Nodes to COVID-19 Vaccination on 18F-rhPSMA-7.3 PET/CT in Patients with Prostate Cancer

Susan Notohamiprodjo et al. J Nucl Med. 2022 Nov.

Abstract

Vaccine-associated lymphadenopathy (VAL) is a common finding on 18F-FDG PET/CT examinations after coronavirus disease 2019 (COVID-19) vaccination. However, data regarding VAL on 18F-rhPSMA-7.3-ligand PET are currently lacking. This study assesses the prevalence, temporal response to vaccination, and characteristics of VAL. Methods: Two hundred thirty-three consecutive vaccinated and 41 unvaccinated patients with confirmed prostate cancer who underwent 18F-rhPSMA-7.3 PET/CT were retrospectively analyzed. Size and uptake of the axillary lymph nodes were measured. Ratios of SUVmax of ipsilateral to contralateral axillary lymph node (SUVratio) were determined. The characteristics of SUVratio in respect to the duration of PSMA avidity in the axillary lymph node after COVID-19 vaccination was analyzed. Results: The prevalence of VAL on 18F-rhPSMA-7.3 PET was 45%. Up to a period of 8 wk after the last COVID-19 vaccination, SUVratio was positive (2.05 ± 0.17). Thereafter, SUVratio dropped significantly (1.35 ± 0.09) and approached the value of unvaccinated group (1.1 ± 0.2). SUVratio of metastatic axillary lymph nodes was very high (>11) and can be easily detected visually or semiquantitatively. In 3 patients, we observed suspected development and consecutively confirmed involving metastasis of axillary lymph node with SUVratio between 4.0 to 6.6. Correlation between SUVratio and lymph node size (r = 0.93, P < 0.0001) and lymph node size and duration after vaccine (r = -0.88, P < 0.0008) was found. Conclusion: Increased uptake of the PSMA ligand 18F-rhPSMA-7.3 by axillary lymph nodes is common after COVID-19 vaccination and can persist for 8 wk. This finding should be considered in the interpretation of 18F-rhPSMA-7.3 PET/CT examinations.

Keywords: COVID-19 vaccine; PSMA-ligand PET/CT; axillary lymphadenopathy; rhPSMA.

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Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Temporal response of SUVratio after COVID-19 vaccination on PSMA PET/CT. Error bars indicate SD. vac = vaccinated; 0-vac = unvaccinated; n.s = statistically not significant.
FIGURE 2.
FIGURE 2.
Relation between SUVratio and lymph node size on PSMA PET/CT. Error bars indicate SD. vac = vaccinated.
FIGURE 3.
FIGURE 3.
Relation between lymph node size and duration after vaccination. Error bars indicate SD. vac = vaccinated.
FIGURE 4.
FIGURE 4.
Representative PSMA PET/CT images of a patient with VAL (A) and of another patient with axillary lymph node metastasis (B).
See this image and copyright information in PMC

Comment in

  • Reply: PSMA Is Not Specific to Prostate Cancer.
    Notohamiprodjo S, Eiber M, Lohrmann C, Weber WA. Notohamiprodjo S, et al. J Nucl Med. 2023 Aug;64(8):1326-1327. doi: 10.2967/jnumed.123.265921. Epub 2023 Jun 22. J Nucl Med. 2023. PMID: 37348916 No abstract available.
  • PSMA Is Not Specific to Prostate Cancer.
    Ah-Thiane L, Ferrer L, Rousseau C. Ah-Thiane L, et al. J Nucl Med. 2023 Aug;64(8):1326. doi: 10.2967/jnumed.123.265720. Epub 2023 Jun 22. J Nucl Med. 2023. PMID: 37348920 No abstract available.

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