Objective To evaluate the application value of 18F-fluorodeoxyglucose (18FFDG) coincidence single photon emission computed tomography (SPECT/CT) imaging in the follow up after lung cancer operation. Methods The clinical data of 56 patients with lung cancer who underwent radical resection in our hospital between March 2012 and May 2013 were retrospectively analyzed. All cases were effectively followed up after operation. With postoperative pathological results as golden standard, the application value of 18F-FDG coincidence SPECT/CT imaging in follow-up after lung cancer operation was evaluated. Results The number of patients with recurrent residual, recurrent residual complicated with metastatic lesions, single lesion, multiple metastases, without obvious recurrence and metastasis in chest were 14, 9, 4, 13 and 12 respectively. The sensitivity, specificity and accuracy of 18F-FDG coincidence SPECT/CT imaging in the diagnosis of recurrent lung cancer were 93.18% (41/44), 75.00% (9/12) and 83.93% (47/56), respectively. The positive and negative predictive values were 93.18% (41/44) and 75.00% (9/12) respectively. Conclusion 18F-FDG line SPECT/CT imaging is of certain value in the diagnosis of lung cancer, and the value in the diagnosis of follow-up recurrence after operation is high, which provides important references for clinical physicians to develop adjuvant chemotherapy program.