Prognostic utility of 18F-FDG PET/MRI with intravoxel incoherent motion imaging in nasopharyngeal carcinoma

Sheng-Chieh Chan; Shu-Hang Ng; Chih-Hua Yeh; Yu-Chun Lin; Chien-Yu Lin; Jen-Hung Wang; Nai-Ming Cheng; Shih-Hsin Chen; Kai-Ping Chang; Jason Chia-Hsun Hsieh

doi:10.1007/s00259-025-07425-6

Prognostic utility of ¹⁸F-FDG PET/MRI with intravoxel incoherent motion imaging in nasopharyngeal carcinoma

Eur J Nucl Med Mol Imaging. 2025 Jul 2. doi: 10.1007/s00259-025-07425-6. Online ahead of print.

Authors

Sheng-Chieh Chan^{1

2}, Shu-Hang Ng³, Chih-Hua Yeh⁴, Yu-Chun Lin⁴, Chien-Yu Lin⁵, Jen-Hung Wang⁶, Nai-Ming Cheng⁷, Shih-Hsin Chen⁷, Kai-Ping Chang⁸, Jason Chia-Hsun Hsieh⁹

Affiliations

¹ Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
² School of Medicine, Tzu Chi University, Hualien, Taiwan.
³ Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 333423, Taoyuan, Taiwan. shuhangng@gmail.com.
⁴ Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital, Chang Gung University, 333423, Taoyuan, Taiwan.
⁵ Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, 333423, Taiwan.
⁶ Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
⁷ Department of Nuclear Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
⁸ Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
⁹ Division of Hematology/Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.

PMID: 40601020
DOI: 10.1007/s00259-025-07425-6

Abstract

Purpose: Intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) enhances tissue diffusion assessment by differentiating true molecular diffusion from microvascular perfusion, surpassing conventional DWI. This prospective study assessed the prognostic utility of ¹⁸F-FDG PET/MRI with IVIM imaging in patients with primary nasopharyngeal carcinoma (NPC).

Methods: We prospectively enrolled 148 patients with primary NPC who underwent pretreatment PET/MRI. Quantitative parameters derived from IVIM-DWI, dynamic contrast-enhanced MRI (DCE-MRI), and ¹⁸F-FDG PET were analyzed for their associations with overall survival (OS) and recurrence-free survival (RFS).

Results: IVIM-derived minimal true diffusion coefficient (D_min) and perfusion-related diffusion coefficient (D*) were correlated with RFS (p = 0.018 and 0.043, respectively), outperforming the apparent diffusion coefficient (ADC; p = 0.946). Univariate analysis identified age, tumour stage, T classification, primary tumour standardized uptake value (SUVt), nodal SUV (SUVn), and total lesion glycolysis (TLG) as significant OS predictors. Significant predictors of RFS included Epstein-Barr virus DNA titer, SUVn, DCE-MRI parameters (K_ep and V_e), and IVIM parameters (D* and D_min). In multivariate analysis, age, SUVt, and TLG were independent OS prognostic factors, whereas SUVn, K_ep, D_min (p = 0.009), and V_e (p = 0.012) independently predicted RFS. Prognostic models incorporating the PET/MRI imaging biomarkers showed a significantly higher integrated AUC and Harrell's C-index than the TNM staging system alone.

Conclusion: Integrated PET/MRI with IVIM imaging enables simultaneous quantification of water molecule diffusion, tumor microvascular perfusion, and glucose metabolism in NPC, yielding complementary imaging biomarkers that demonstrate superior prognostic value compared to conventional TNM staging.

Trial registration: ClinicalTrials.gov (NCT03429868), retrospectively registered on February 6, 2018.

Keywords: Intravoxel incoherent motion diffusion; Nasopharyngeal carcinoma; Overall survival; Positron emission tomography/Magnetic resonance imaging; Prognosis; Recurrence-free survival.

Associated data

ClinicalTrials.gov/NCT03429868

Abstract

Associated data

Grants and funding