BackgroundRespiratory motion during PET acquisition may result in image blurring and resolution loss, reduced measurement of radiotracer uptake, and consequently, inaccurate lesion quantification and description. With the introduction of the total-body PET system, short-time PET acquisition is feasible due to its high sensitivity and spatial resolution. The purpose of this study was to evaluate the additional value of 20-s breath-hold (BH) lung PET in patients with stage IA pulmonary adenocarcinoma.MethodsForty-seven patients with confirmed stage IA pulmonary adenocarcinoma were enrolled in this retrospective study. All patients underwent a 300-s FB whole-body PET, followed by a BH lung PET. The SUVmax, TBR of the lesions and the percentage difference in nodule SUVmax(%ΔSUVmax) and TBR (%ΔTBR) between the two acquisitions was also calculated. The lesions were further divided by distance from pleura for subgroup analysis. The lesion detectability on PET images was the percentage of FDG-positive lesions.ResultsAmong 47 patients, the BH lung PET images identified all lung nodules, and there was a significant difference in overall nodule SUVmaxand TBR between BH PET and FB PET (bothp< 0.01). The %ΔSUVmaxand %ΔTBR were significantly higher in nodules adjacent to pleura (≤ 10 mm in distance) than those away from pleura (bothp< 0.05). The lesion detectability of BH lung PET was significantly higher than that of FB PET (p< 0.01).ConclusionBH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma.Critical relevance statementBH PET acquisition is a practical way to minimize motion artifacts in PET which has the potential to improve lesion detection for stage IA pulmonary adenocarcinoma.Graphical Abstract