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Background  The aim of this study was to investigate whether the maximum standardized uptake value (SUVmax) measured on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) could be used as the primary means of differential diagnosis of thyroid nodules when tumor volume is assessed.    Methods  We studied 192 patients who underwent preoperative  18 F-FDG PET/CT followed by thyroidectomy. We evaluated the correlation between the volume of thyroid nodules,  18 F-FDG uptake on visual analysis, and the mean SUVmax measured on  18 F-FDG PET/CT.    Results  When stratified by tumor volume, the mean SUVmax was higher in malignant than in benign nodules in nodules ≥1 cm 3  ( p  &lt; 0.001). However, it did not differ between benign and malignant nodules smaller than 1 cm 3 . At a cut-off value of SUVmax of 6, the respective sensitivities of  18 F-FDG PET/CT, ultrasonography, and fine needle aspiration cytology were 60.8, 96.4, and 99.1 %, and the respective specificities were 95.9, 98.2, and 96.8 %.    Conclusions   18 F-FDG PET/CT is limited as a primary modality in the differential diagnosis of benign and malignant thyroid nodules because of its low sensitivity.

SUVmax of 18F-FDG PET/CT in the differential diagnosis of benign and malignant thyroid nodules according to tumor volume