DOI: 10.1007/s00259-018-4043-yPages: 1908-1914

Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial

1. Ospedale del Mare, Struttura Complessa di Medicina Nucleare

2. Ospedale San Giuseppe Moscati, Struttura Complessa di Medicina Nucleare

3. Università degli Studi di Salerno, Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana”

4. Istituto Oncologico Veneto IOV – IRCCS, SSD Medicina Nucleare e Imaging Molecolare

5. Centro Interuniversitario di Ricerca per lo Sviluppo Sostenibile

6. Università degli Studi di Bologna, Servizio di Medicina Nucleare, Policlinico S. Orsola Malpighi

7. Università degli Studi di Napoli Federico II, Dipartimento di Scienze Biomediche Avanzate

8. Università di Milano Bicocca, Unità di Medicina Nucleare, Ospedale San Gerardo

9. Humanitas Research Hospital, Unità di Medicina Nucleare, Cancer Center

10. Medicina Futura IOS, Unità di Medicina Nucleare, Dipartimento delle Immagini

11. SDN-IRCCS, Unità di Medicina Nucleare, Dipartimento delle Immagini

12. Centro di Riferimento Oncologico della Basilicata-IRCCS, Unità di Medicina Nucleare

13. Ospedale Universitario Integrato di Verona, Unità di Medicina Nucleare, Dipartimento delle Immagini

14. Università Cattolica del Sacro Cuore, Istituto di Medicina Nucleare

15. Ospedale di Bolzano, Dipartimento di Medicina Nucleare

16. Università Tor Vergata, Dipartimento di Biomedicina e Prevenzione

17. IRCCS-Neuromed, Servizio di Medicina Nucleare

18. Ospedale San Giuseppe Moscati, Divisione di Oncologia Medica

Correspondence to:
Marco Spadafora




Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT.


18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference.


In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT.


Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary.

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  • Accepted: Apr 26, 2018
  • Online: May 5, 2018

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