Background and purpose: F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has a low sensitivity for primary renal cell carcinoma (RCC) de-tection. Then, evidence suggests that FDG PET or PET/computed tomography (CT) is a valuable tool in the detection of metastatic or recurrent lesions in patients with RCC. This study aims to explore whether renal cell carcinoma growth may change into FDG metabolism associated with metastasis. Methods: We reviewed retrospectively the medical records of 22 patients with RCC (clear cell type) seen at our institution’s PET center. Of these 22 patients, 14 patients have an incidental finding of renal lesion on FDG PET/CT scans and histopathologically proven RCC without metastasis later (as group A). 8 patients have RCC with extra-renal metastasis lesion on FDG PET/CT scans of the whole body (as group B). Results: Talking about the relationship among baseline characteristics of all patients in our study, a positive correlation was found in tumor size between with SUVmean (r=0.80, p<0.001) of FDG uptake in the renal tu-mor. In addition, there was a positive correlation between metastasis status and SU-Vmean (r=0.64, p=0.001) as well as tumor size (r=0.66, p=0.001). When an RCC tu-mor size larger than 4 cm and a visual score larger than 1 were used as the cutoff value in our study, the area under the curve (AUC) was 0.902 (95% CI: 0.77-1.00), with sensitivity of 100% and specificity of 85.7%. Conclusion: FDG PET/CT shows RCC growth larger than 4 cm may change into FDG metabolism and metastasis.