key: cord-0896930-knp78a27
authors: Guglielmo, Priscilla; Muccioli, Simona; Berti, Sara; Sartorello, Alida; Pesella, Fiammetta; Gregianin, Michele
title: Detection of Unilateral Axillary Nodal Uptake Both at (68)Ga-DOTATOC and (18)F-FDG PET/CT After 1 Week From COVID-19 Vaccine
date: 2021-09-15
journal: Clin Nucl Med
DOI: 10.1097/rlu.0000000000003918
sha: 1afb097c49455862a57a2d2fdccd3bf28fdb55e8
doc_id: 896930
cord_uid: knp78a27

Recently, vaccination against COVID-19 has gained wide diffusion, especially among vulnerable individuals, such as cancer patients. At the same time, patients have been undergoing PET/CT examinations after vaccination in an increasing number, and cases of false-positive axillary nodal uptake have been described, mostly at (18)F-FDG PET. Here, we describe the case of both (68)Ga-DOTATOC and (18)F-FDG axillary nodal uptake in a young woman affected by a metastatic retroperitoneal paraganglioma.

FIGURE 1. We describe the case of a 29-year-old woman with stage IV retroperitoneal paraganglioma and disseminated bone metastases, who underwent both 68 Ga-DOTATOC and 18 F-FDG PET/CT during her follow-up. After the injection of 101 MBq of 68 Ga-DOTATOC, the PET/CT examination revealed a stable disease in the already known numerous bone and pulmonary metastases; furthermore, a mild uptake was demonstrated in some small left axillary nodes (white and black arrows; A, MIP; B, axial PET image; C, CT image; D, fused PET/CT image). The day after, she underwent 18 F-FDG PET/CT confirming bone and lung lesions and a mild uptake (SUV max , 3.80) in the left axillary region, corresponding to the small nodes with fatty hilus previously observed (white and black arrows; E, axial PET image; F, CT image; G, fused PET/CT image; H, MIP). A fade uptake was also detected within the subcutaneous soft tissues superficial to the left deltoid muscle. The patient presented a history of receiving the Pfizer-BioNTech COVID-19 vaccine in the left deltoid muscle 6 and 7 days before the 68 Ga-DOTATOC and the 18 F-FDG PET/CT, respectively. Tracer injection was via the right (contralateral) antecubital fossa in both examinations, hence not a potential cause. Clinical correlation and its morphological aspect supported the nodal uptake to be reactive, ascribed to the recent vaccination. Similar findings were described after COVID-19 vaccinations (both Pfizer-BioNTech and AZ) on 18 F-FDG PET/CT [1] [2] [3] [4] [5] [6] [7] and, recently, also on 18 F-choline PET/CT examination. 8 To the best of our knowledge, this is the first case of a COVID-19 vaccine-related nodal uptake on 68 Ga-DOTATOC PET/CT, as very recently another case involving 68 Ga-DOTATATE PET/CT had been reported. 9 This case highlights another potential pitfall associated with the current COVID-19 pandemic vaccination program, which may result in incorrect image interpretation and inadvertent disease upstaging.

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DOTATATE-avid bilateral axilla and subpectoral lymphadenopathy induced from COVID-19 mRNA vaccination visualized on PET/CT. Clin Nucl Med. 2021

The authors would like to thank the technicians, the nurses, and all the members of the nuclear medicine unit.