Chan Sheng-Chieh, Ng Shu-Hang, Yeh Chih-Hua, Lin Yu-Chun, Lin Chien-Yu, Wang Jen-Hung, Cheng Nai-Ming, Chen Shih-Hsin, Chang Kai-Ping, Hsieh Jason Chia-Hsun
Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
School of Medicine, Tzu Chi University, Hualien, Taiwan.
Eur J Nucl Med Mol Imaging. 2025 Jul 2. doi: 10.1007/s00259-025-07425-6.
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 F-FDG PET/MRI with IVIM imaging in patients with primary nasopharyngeal carcinoma (NPC).
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 F-FDG PET were analyzed for their associations with overall survival (OS) and recurrence-free survival (RFS).
IVIM-derived minimal true diffusion coefficient (D) 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 and V), and IVIM parameters (D* and D). In multivariate analysis, age, SUVt, and TLG were independent OS prognostic factors, whereas SUVn, K, D (p = 0.009), and V (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.
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.
ClinicalTrials.gov (NCT03429868), retrospectively registered on February 6, 2018.
体素内不相干运动（IVIM）扩散加权成像（DWI）通过区分真正的分子扩散与微血管灌注来增强组织扩散评估，优于传统DWI。本前瞻性研究评估了F-FDG PET/MRI联合IVIM成像在原发性鼻咽癌（NPC）患者中的预后价值。
我们前瞻性纳入了148例接受治疗前PET/MRI检查的原发性NPC患者。分析了从IVIM-DWI、动态对比增强MRI（DCE-MRI）和F-FDG PET获得的定量参数与总生存期（OS）和无复发生存期（RFS）的相关性。
IVIM衍生的最小真实扩散系数（D）和灌注相关扩散系数（D*）与RFS相关（分别为p = 0.018和0.043），优于表观扩散系数（ADC；p = 0.946）。单因素分析确定年龄、肿瘤分期、T分类、原发肿瘤标准化摄取值（SUVt）、淋巴结SUV（SUVn）和总病变糖酵解（TLG）为OS的显著预测因素。RFS的显著预测因素包括爱泼斯坦-巴尔病毒DNA滴度、SUVn、DCE-MRI参数（K和V）以及IVIM参数（D*和D）。多因素分析中，年龄、SUVt和TLG是独立的OS预后因素，而SUVn、K、D（p = 0.009）和V（p = 0.012）独立预测RFS。纳入PET/MRI成像生物标志物的预后模型显示，其综合AUC和Harrell's C指数显著高于单独的TNM分期系统。
PET/MRI联合IVIM成像能够同时定量NPC中的水分子扩散、肿瘤微血管灌注和葡萄糖代谢，产生与传统TNM分期相比具有更高预后价值的互补成像生物标志物。
ClinicalTrials.gov（NCT03429868），于2018年2月6日进行回顾性注册。
