Advances in imaging of the solitary pulmonary nodule.

OBJECTIVE To review the radiological management of a solitary pulmonary nodule. DATA SOURCES MEDLINE literature search (1958-2002). STUDY SELECTION All review articles and original articles. Key words for the literature search were 'solitary pulmonary nodule' and 'imaging'. DATA EXTRACTION All relevant information and data. DATA SYNTHESIS The solitary pulmonary nodule remains a perennial problem in radiological practice, particularly with current trends using low-dose computed tomography to screen for lung cancer. Determining the likelihood of malignancy forms the basis of the radiological approach of a solitary pulmonary nodule. Several factors that influence risk analysis include morphological and enhancement characteristics of the solitary pulmonary nodule on imaging, stability of the nodule, age of patient, smoking history, and history of malignant disease. Other ancillary procedures and imaging techniques that assist in the evaluation of a solitary pulmonary nodule include fluorodeoxyglucose positron-emission tomography, technetium Tc 99m depreotide imaging, bronchoscopy with bronchioloalveolar lavage and biopsy, image-guided transthoracic needle aspiration biopsy, video-assisted thorascopic surgery, and thoracotomy. CONCLUSIONS The success of any radiological management of a solitary pulmonary nodule rests on careful clinical evaluation and risk stratification for malignancy before the implementation of appropriate imaging techniques.