Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Computed tomographic and positron emission tomographic scanning of pulmonary nodules

Paul Stark, MD
Section Editor
Nestor L Muller, MD, PhD
Deputy Editor
Geraldine Finlay, MD


Computed tomography (CT) is an important tool in the evaluation of solitary and multiple pulmonary nodules. It determines the morphology and attenuation characteristics of nodules, defines additional nodules that may not be visible on conventional radiography, and detects additional intrathoracic abnormalities, such as enlarged mediastinal lymph nodes. CT provides clues to the nature of the nodule(s), as well as global thoracic assessment that may help guide patient management. (See "High resolution computed tomography of the lungs".)

Positron emission tomography (PET) is a nuclear imaging modality that provides insight into the metabolic activity of a pulmonary lesion and, by inference, yields information about the probability of malignancy. (See "Thoracic positron emission tomography".)

The use of CT and PET in the evaluation of solitary or multiple pulmonary nodules will be presented here. General issues related to the differential diagnosis and evaluation of the solitary pulmonary nodule are discussed separately. (See "Diagnostic evaluation and management of the solitary pulmonary nodule".)


CT is the imaging modality most often used to evaluate pulmonary nodules. In this section, we review technical aspects of CT and the use of CT in the evaluation of pulmonary nodules.

Technical aspects — Helical CT (ie, spiral CT) has several technical advantages in the evaluation of pulmonary nodules, compared to conventional, axial, step and shoot CT:


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Mar 9, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Costello P, Anderson W, Blume D. Pulmonary nodule: evaluation with spiral volumetric CT. Radiology 1991; 179:875.
  2. Remy-Jardin M, Remy J, Giraud F, Marquette CH. Pulmonary nodules: detection with thick-section spiral CT versus conventional CT. Radiology 1993; 187:513.
  3. Costello P. Spiral CT of the thorax. Semin Ultrasound CT MR 1994; 15:90.
  4. Seltzer SE, Judy PF, Adams DF, et al. Spiral CT of the chest: comparison of cine and film-based viewing. Radiology 1995; 197:73.
  5. Buckle CE, Udawatta V, Straus CM. Now you see it, now you don't: visual illusions in radiology. Radiographics 2013; 33:2087.
  6. Winer-Muram HT. The solitary pulmonary nodule. Radiology 2006; 239:34.
  7. Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics 2000; 20:43.
  8. Erasmus JJ, McAdams HP, Connolly JE. Solitary pulmonary nodules: Part II. Evaluation of the indeterminate nodule. Radiographics 2000; 20:59.
  10. Zerhouni EA, Stitik FP, Siegelman SS, et al. CT of the pulmonary nodule: a cooperative study. Radiology 1986; 160:319.
  11. Siegelman SS, Khouri NF, Leo FP, et al. Solitary pulmonary nodules: CT assessment. Radiology 1986; 160:307.
  12. MacMahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005; 237:395.
  13. Midthun, DE, Swensen, SJ, Jett, JR. Evaluation of nodules detected by screening for lung cancer with low dose spiral computed tomography. Lung Cancer 2003; 41:S40.
  14. Yanagawa M, Tanaka Y, Leung AN, et al. Prognostic importance of volumetric measurements in stage I lung adenocarcinoma. Radiology 2014; 272:557.
  15. Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2013; 266:304.
  16. Lee SM, Park CM, Goo JM, et al. Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology 2013; 268:265.
  17. Godoy MC, Naidich DP. Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology 2009; 253:606.
  18. Travis WD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6:244.
  19. Rigler LG. An overview of cancer of the lung. Semin Roentgenol 1977; 12:161.
  20. Henschke CI, Yankelevitz DF, Mirtcheva R, et al. CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 2002; 178:1053.
  21. Winer-Muram HT, Jennings SG, Tarver RD, et al. Volumetric growth rate of stage I lung cancer prior to treatment: serial CT scanning. Radiology 2002; 223:798.
  22. Tsubamoto M, Kuriyama K, Kido S, et al. Detection of lung cancer on chest radiographs: analysis on the basis of size and extent of ground-glass opacity at thin-section CT. Radiology 2002; 224:139.
  23. Remy J, Remy-Jardin M, Wattinne L, Deffontaines C. Pulmonary arteriovenous malformations: evaluation with CT of the chest before and after treatment. Radiology 1992; 182:809.
  24. Ahn MI, Gleeson TG, Chan IH, et al. Perifissural nodules seen at CT screening for lung cancer. Radiology 2010; 254:949.
  25. de Hoop B, van Ginneken B, Gietema H, Prokop M. Pulmonary perifissural nodules on CT scans: rapid growth is not a predictor of malignancy. Radiology 2012; 265:611.
  26. Xu DM, van der Zaag-Loonen HJ, Oudkerk M, et al. Smooth or attached solid indeterminate nodules detected at baseline CT screening in the NELSON study: cancer risk during 1 year of follow-up. Radiology 2009; 250:264.
  27. Woodring JH, Fried AM. Significance of wall thickness in solitary cavities of the lung: a follow-up study. AJR Am J Roentgenol 1983; 140:473.
  28. Harris VJ, Brown R. Pneumatoceles as a complication of chemical pneumonia after hydrocarbon ingestion. Am J Roentgenol Radium Ther Nucl Med 1975; 125:531.
  29. Yamamoto S, Korn RL, Oklu R, et al. ALK molecular phenotype in non-small cell lung cancer: CT radiogenomic characterization. Radiology 2014; 272:568.
  30. Naruke T, Goya T, Tsuchiya R, Suemasu K. Prognosis and survival in resected lung carcinoma based on the new international staging system. J Thorac Cardiovasc Surg 1988; 96:440.
  31. Nishino M, Hatabu H, Johnson BE, McLoud TC. State of the art: Response assessment in lung cancer in the era of genomic medicine. Radiology 2014; 271:6.
  32. Honda O, Johkoh T, Sumikawa H, et al. Pulmonary nodules: 3D volumetric measurement with multidetector CT--effect of intravenous contrast medium. Radiology 2007; 245:881.
  33. Kim H, Park CM, Woo S, et al. Pure and part-solid pulmonary ground-glass nodules: measurement variability of volume and mass in nodules with a solid portion less than or equal to 5 mm. Radiology 2013; 269:585.
  34. Chae HD, Park CM, Park SJ, et al. Computerized texture analysis of persistent part-solid ground-glass nodules: differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas. Radiology 2014; 273:285.
  35. Williams DE, Pairolero PC, Davis CS, et al. Survival of patients surgically treated for stage I lung cancer. J Thorac Cardiovasc Surg 1981; 82:70.
  36. Midthun DE, Swensen SJ, Jett JR. Approach to the solitary pulmonary nodule. Mayo Clin Proc 1993; 68:378.
  37. Song YS, Park CM, Park SJ, et al. Volume and mass doubling times of persistent pulmonary subsolid nodules detected in patients without known malignancy. Radiology 2014; 273:276.
  38. Libshitz HI, North LB. Pulmonary metastases. Radiol Clin North Am 1982; 20:437.
  39. Chang AE, Schaner EG, Conkle DM, et al. Evaluation of computed tomography in the detection of pulmonary metastases: a prospective study. Cancer 1979; 43:913.
  40. Lowe VJ, Naunheim KS. Positron emission tomography in lung cancer. Ann Thorac Surg 1998; 65:1821.
  41. Nolop KB, Rhodes CG, Brudin LH, et al. Glucose utilization in vivo by human pulmonary neoplasms. Cancer 1987; 60:2682.
  42. Vansteenkiste JF, Stroobants SS. PET scan in lung cancer: current recommendations and innovation. J Thorac Oncol 2006; 1:71.
  43. Vansteenkiste JF, Stroobants SG. The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology. Eur Respir J 2001; 17:802.
  44. Fischer BM, Mortensen J, Højgaard L. Positron emission tomography in the diagnosis and staging of lung cancer: a systematic, quantitative review. Lancet Oncol 2001; 2:659.
  45. Vansteenkiste JF. Nodules, CT-scans and PET-scans: a good partnership. Lung Cancer 2004; 45:29.
  46. Lowe VJ, Hoffman JM, DeLong DM, et al. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities. J Nucl Med 1994; 35:1771.
  47. Cook GJ, O'Brien ME, Siddique M, et al. Non-Small Cell Lung Cancer Treated with Erlotinib: Heterogeneity of (18)F-FDG Uptake at PET-Association with Treatment Response and Prognosis. Radiology 2015; 276:883.
  48. Soussan M, Cyrta J, Pouliquen C, et al. Fluorine 18 fluorodeoxyglucose PET/CT volume-based indices in locally advanced non-small cell lung cancer: prediction of residual viable tumor after induction chemotherapy. Radiology 2014; 272:875.
  49. Yi CA, Lee KS, Kim BT, et al. Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT. J Nucl Med 2006; 47:443.
  50. Kim SK, Allen-Auerbach M, Goldin J, et al. Accuracy of PET/CT in characterization of solitary pulmonary lesions. J Nucl Med 2007; 48:214.
  51. Bar-Shalom R, Kagna O, Israel O, Guralnik L. Noninvasive diagnosis of solitary pulmonary lesions in cancer patients based on 2-fluoro-2-deoxy-D-glucose avidity on positron emission tomography/computed tomography. Cancer 2008; 113:3213.