Background/Objectives:Pulmonary nodules (PNs) are a common incidental finding on conventional imaging. Differentiating benign from malignant lesions remains a diagnostic challenge. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has become an essential imaging modality in this setting. This review aims to evaluate the clinical impact of PET/CT parameters and techniques, focusing on semi-quantitative imaging biomarkers and dual-time-point imaging.Methods:This review is organized into three main sections. First, qualitative analysis and PET key metrics are analyzed, including standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) indices, highlighting their diagnostic and prognostic significance. The second section focuses on the clinical utility of dual-time-point imaging (DTPI), evaluating its ability to differentiate between benign and malignant PNs through changes in SUV over time (ΔSUVmax). We compare these advanced imaging approaches with histopathological diagnosis, the current gold-standard method, highlighting the potential of advanced PET/CT techniques in clinical decision-making. The last section focuses on future applications of PET/MR, artificial intelligence, and PET radiomics.Results:Evidence indicates that high SUV, MTV, and TLG values are significantly associated with malignant PNs and aggressiveness. Moreover, DTPI with ΔSUV, ΔMTV, and ΔTLG further enhances specificity and accuracy in characterizing PNs. Despite a lack of standardization, studies have shown better accuracy when advanced PET/CT parameters are used.Conclusions:While DTPI and semi-quantitative PET parameters are not yet universally adopted in daily clinical practice, evidence supports their role in enhancing the characterization of indeterminate PNs. More prospective studies are needed.
背景/目的：肺结节是常规影像检查中常见的偶然发现。鉴别良恶性病变仍是诊断难题。18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描已成为该领域重要的影像学检查手段。本综述旨在评估PET/CT参数与技术的临床价值，重点关注半定量影像生物标志物及双时相成像技术。 方法：本综述分为三个主要部分。首先分析定性评估及PET关键指标，包括标准化摄取值最大值、代谢肿瘤体积和病灶糖酵解总量等参数，重点阐述其诊断与预后价值。第二部分聚焦双时相成像的临床应用，通过评估标准化摄取值随时间变化量分析其鉴别肺结节良恶性的能力。我们将这些先进成像方法与当前金标准——组织病理学诊断进行对比，凸显先进PET/CT技术在临床决策中的潜力。最后部分探讨PET/MR、人工智能及PET影像组学的未来应用前景。 结果：证据表明高标准化摄取值最大值、代谢肿瘤体积和病灶糖酵解总量值与恶性肺结节及其侵袭性显著相关。此外，基于标准化摄取值变化量、代谢肿瘤体积变化量和病灶糖酵解总量变化量的双时相成像技术能进一步提升肺结节定性诊断的特异性与准确性。尽管缺乏统一标准，研究显示采用先进PET/CT参数可获得更优的诊断准确性。 结论：虽然双时相成像与半定量PET参数尚未在临床实践中普及，现有证据支持其在提升不确定性肺结节定性诊断中的作用。未来仍需开展更多前瞻性研究。
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