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To investigate whether the FD of non-small cell lung cancer (NSCLC) on CT predicts tumor stage and uptake on 18F-fluorodeoxyglucose positron emission tomography. The FD within a tumor region was determined using a box counting algorithm and compared to the lymph node involvement (NI) and metastatic involvement (MI) and overall stage as determined from PET. A Mann-Whitney U test was applied to the extracted FD features for the NI and the MI. The two tests showed good significance with p <.05 (p NI = 0.0139, p MI = 0.0194). Also after performing fractal analysis to all cases, it was found that for those who had a CT of stage I or II had a higher likelihood of the NI and/or MI stage being upstaged by PET, Odds Ratio 5.38 (95% CI 0.99–29.3). For those who are CT stage III or IV had an increased likelihood of the NI and/or MI stage being down staged by PET, Odds Ratio: 7.33 (95% CI 0.48–111.2). Initial results of this study indicate higher FD in CT images of NSCLC is associated with advanced stage and greater FDG uptake on PET. Measurements of tumor fractal analysis on conventional non-contrast CT examinations could potentially be used as a prognostic marker and/or to select patients for PET. Unlabelled Image • Fractal analysis can quantify complexity within image texture. • Conventional non-contrast enhanced CT scans are employed. • Fractal dimension (FD) estimated within a tumor region using box counting algorithm • FD values correlate with PET lymph node, metastasis and overall tumor stage. • Fractal analysis could potentially be used as a prognostic marker and/or to select patients for PET. [ABSTRACT FROM AUTHOR]