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Review
. 2022;10(6):631-642.
doi: 10.1007/s40336-022-00521-9. Epub 2022 Aug 16.

COVID-19 vaccination, implications for PET/CT image interpretation and future perspectives

Margarita Kirienko #  1 , Matteo Biroli #  2 , Cristiano Pini  2   3 , Fabrizia Gelardi  2   3 , Martina Sollini  2   3 , Arturo Chiti  2   3
Affiliations
Review

COVID-19 vaccination, implications for PET/CT image interpretation and future perspectives

Margarita Kirienko et al. Clin Transl Imaging. 2022.

Abstract

Introduction: The present paper aims to systematically review the literature on COVID-19 vaccine-related findings in patients undergoing PET/CT.

Methods: The search algorithms included the following combination of terms: "PET" OR "positron emission tomography" AND "COVID"; "PET" OR "positron emission tomography" AND "COVID" AND "vaccination"; "PET" OR "positron emission tomography" AND "COVID", AND "autoimmune".

Results: We selected 17 articles which were assessed for quality and included in the systematic analysis. The most frequent vaccine-related signs on PET/CT were the deltoid [18F]FDG uptake and axillary hypermetabolic lymph nodes, which were described in 8-71% and 7-90% of the patients, respectively. Similarly, frequency of these findings using other tracers than [18F]FDG was greatly variable. This large variability was related to the variability in time elapsed between vaccination and PET/CT, and the criteria used to define positivity. In addition, vaccine-related findings were detected more frequently in young and immunocompetent patients than in elderly and immunocompromised ones.

Discussion: Therefore, awareness on vaccination status (timing, patient characteristics, and concurrent therapies) and knowledge on patterns of radiopharmaceutical uptake are necessary to properly interpret PET/CT findings.

Keywords: COVID-19; Infection; Inflammation; PET/CT; SARS-CoV-2; Vaccination.

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Conflict of interest statement

Conflict of interestProf. Chiti reports a fellowship grant from Sanofi, personal fees from AAA, Blue Earth Diagnostics and General Electric Healthcare, outside the submitted work. The other authors do not report any conflict of interest.

Figures

Fig. 1
Fig. 1
Paper selection process
Fig. 2
Fig. 2
Quality assessment according to QUADAS-2 of the 17 articles included in the systematic review
Fig. 3
Fig. 3
Examples of vaccine-related findings in patients who underwent [18F]FDG PET/CT for staging. Maximum intensity projection (MIP) image (A) shows the “double sign” in a multiple myeloma patient who received the third COVID-19 vaccination on the right side, 2 days prior PET/CT. MIP image (B) of a left breast cancer patient with omolateral “double sign”, who has been injected with the fourth dose of COVID-19 vaccination on the left side, 7 days prior the scan
Fig. 4
Fig. 4
Examples of potential interpretative PET/CT pitfalls in oncology. [18F]FDG uptake along the trachea due to Aspergillosis in a patient with lymphoma during immunotherapy (A). [18F]FDG uptake in the right breast related to post-bioptic hematoma in a lymphoma patient (B). Bone-marrow biopsy caused [18F]FDG uptake in the left iliac bone in a lymphoma patient (C). Mild [11C]Choline uptake in left lung due to pneumonitis (D). Moderate focal [68Ga]Ga-DOTATOC uptake in the right gluteus related to somatostatin analogues injection in a patient with neuroendocrine tumor (E)
Fig. 5
Fig. 5
[18F]FDG PET/CT in a patient with a solitary pulmonary nodule in the left lung. MIP image shows high uptake in the left lung, moderate uptake in some left supraclavicular and axillary lymph nodes, and a faint “double sign” on the right side. The patient received, 5 days before the scan, the third dose of COVID-19 vaccination on the left side, and the H1N1 vaccine on the right one
See this image and copyright information in PMC

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