Dear Sir,
The publication “18 Fluorodeoxyglucose PET/CT findings in a systemic inflammatory response syndrome after COVID-19 vaccine” reports the case of a 65-year-old woman with increased glucose metabolism in lymphoid tissues diagnosed on [18F]-FDG PET/CT performed 4 days after the first dose of mRNA COVID-19 vaccine [1]. This finding highlights the phenomenon of reactive adenopathy on imaging examinations following vaccination and the need for increasing public awareness and guidelines for clinical practice [2].
The Lancet report also raises the potential of [18F]-FDG PET/CT as a potent tool to assess immune response after mRNA vaccinations. There is now an abundance of evidence demonstrating that immune response increases glucose metabolism in lymphoid organs, which are critical modulators of T-cell immunity [3].
The technology of mRNA vaccination offers promising prophylactic and therapeutic potentials in several medical fields including immuno-oncology [4]. Therefore, current oncological clinical trials should consider the potential theranostic value of [18F]-FDG PET and correlate temporal changes in glucose metabolism of lymphoid tissues with treatment outcome. For instance, a rapid and transient increase in spleen glucose metabolism after RNA cancer vaccine connotes robust immune activation and T-cell proliferation [5]. The same argument can be made for hypermetabolic draining lymph nodes, which could reflect a prominent B cell germinal center activation and an effective humoral response elicited by mRNA vaccine [6].
In conclusion, while the contemporary role of [18F]-FDG PET/CT is predominantly cancer imaging, there is a paradigm shift toward assessing healthy lymphoid tissues for in vivo quantification of the immune response. In the setting of RNA vaccination, this could be used as a theranostic tool for a wide range of indications in multiple therapeutic areas.
References
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Becker AS, Perez-Johnston R, Chikarmane SA, Chen MM, El Homsi M, Feigin KN, et al. Multidisciplinary recommendations regarding post-vaccine adenopathy and radiologic imaging: radiology scientific expert panel. Radiology. 2021;210436. https://doi.org/10.1148/radiol.2021210436.
Cafri G, Gartner JJ, Zaks T, Hopson K, Levin N, Paria BC, et al. mRNA vaccine-induced neoantigen-specific T cell immunity in patients with gastrointestinal cancer. J Clin Invest. 2020;130:5976–88.
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Pektor S, Hilscher L, Walzer KC, Miederer I, Bausbacher N, Loquai C, et al. In vivo imaging of the immune response upon systemic RNA cancer vaccination by FDG-PET. EJNMMI Res. 2018;8:80.
Cohen D, Hazut Krauthammer S, Cohen YC, Perry C, Avivi I, Herishanu Y, et al. Correlation between BNT162b2 mRNA Covid-19 vaccine-associated hypermetabolic lymphadenopathy and humoral immunity in patients with hematologic malignancy. Eur J Nucl Med Mol Imaging [Internet]. 2021 [cited 2021 Jun 3]; Available from: https://link.springer.com/10.1007/s00259-021-05389-x.
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This article is part of the Topical Collection on Oncology - General
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Seban, RD., Champion, L., Yeh, R. et al. Assessing immune response upon systemic RNA vaccination on [18F]-FDG PET/CT for COVID-19 vaccine and then for immuno-oncology?. Eur J Nucl Med Mol Imaging 48, 3351–3352 (2021). https://doi.org/10.1007/s00259-021-05468-z
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DOI: https://doi.org/10.1007/s00259-021-05468-z