key: cord-1006731-789lqag1
authors: Brophy, James; Henkle, Gregory; Rohren, Eric M.
title: DOTATATE Uptake in an Axillary Lymph Node After COVID-19 Vaccination
date: 2021-07-15
journal: Clin Nucl Med
DOI: 10.1097/rlu.0000000000003847
sha: af74af1e327533d056c08afeed47410898e8ebaa
doc_id: 1006731
cord_uid: 789lqag1

A 58-year-old man underwent DOTATATE PET/CT scan for follow-up of pulmonary neuroendocrine tumor after resection and adjuvant chemotherapy. On screening paperwork, the patient indicated having received the Johnson & Johnson/Janssen COVID-19 vaccine (Janssen Biotech, Inc) 1 day previously, administered in the right deltoid muscle. Reactive changes in regional lymph nodes is a known response for all 3 currently Food and Drug Administration–approved COVID-19 vaccines. Recent published data have demonstrated FDG PET-avid axillary lymphadenopathy subsequent to COVID-19 vaccination, and included here is a report of DOTATATE PET-avid axillary lymph node after injection of the Johnson & Johnson COVID-19 vaccine.

A 54-year-old man with pulmonary neuroendocrine tumor underwent surgical resection and adjuvant chemotherapy. A follow-up PET/CT scan using 68 Ga-DOTATATE showed focal uptake in the right axilla (A, axial PET; B, axial CT; C, axial fused; and D, coronal PET), localizing to a nonenlarged lymph node on CT (arrows). DOTATATE PET/CT is an imaging technique frequently used for detecting and characterizing neuroendocrine tumors. DOTATATE is a somatostatin analog that binds with great avidity to somatostatin receptors, allowing highly accurate whole-body imaging of tumors expressing somatostatin receptors. 1,2 DOTATATE uptake secondary to inflammatory processes is a known imaging pitfall, with inflammatory uptake usually seen in the postradiation therapy setting. 2 Inflammatory uptake is frequently low or very low grade. It is important to recognize that nonspecific, inflammatory uptake can also occur with non-FDG radiotracers including DOTATATE. 3 New-onset unilateral and, occasionally, bilateral axillary lymphadenopathy is a commonly reported adverse effect of COVID-19 vaccination. [4] [5] [6] [7] Recent published data have demonstrated FDG PET-avid axillary lymphadenopathy subsequent to COVID-19 vaccination, 3, 8 and this report demonstrates similar findings with DOTATATE. This potential association needs to be recognized by the radiologist, as it may propose a diagnostic dilemma in the workup of metastatic disease. Awareness of each patient's vaccination schedule is an important factor when scheduling imaging for cancer screening or metastatic disease workup.

Neuroendocrine tumor diagnosis and management: 68 Ga-DOTATATE PET/CT

Somatostatin receptor imaging with 68 Ga DOTATATE PET/CT: clinical utility, normal patterns, pearls, and pitfalls in interpretation

COVID-19 vaccination-related uptake on FDG PET/CT: an emerging dilemma and suggestions for management

Unilateral axillary adenopathy in the setting of COVID-19 vaccine

Axillary lymphadenopathy after mRNA COVID-19 vaccination

COVID-19 vaccination-related lymphadenopathy: what to be aware of

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

Imaging of COVID-19 vaccination at FDG PET/CT. Radiology 2021