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Value of integrated PET-IVIM MR in assessing metastases in hypermetabolic pelvic lymph nodes in cervical cancer: a multi-parameter study



To evaluate the value of integrated multi-parameter positron emission tomography-intravoxel incoherent motion magnetic resonance (PET-IVIM MR) imaging for pelvic lymph nodes with high FDG uptake in cervical cancer, and to determine the best combination of parameters.


A total of 38 patients with 59 lymph nodes with high FDG uptake were included. The imaging parameters of the lymph nodes were calculated by PET-IVIM MR, and the differences between lymph nodes diagnosed by postoperative pathology as metastasis versus non-metastasis were compared. We used the receiver operating characteristic (ROC) curve and logistic regression to construct a combination prediction model to filter low value and similar parameters, in order to search the optimal combination of PET/MR parameters for predicting pathologically confirmed metastatic lymph nodes. The correlation between diffusion parameters and metabolic parameters was analyzed by Spearman’s rank correlation.


The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), total metabolic tumor volume (MTV), total lesion glycolysis (TLG), apparent diffusion coefficient (ADC), diffusion-related coefficient (D), and perfusion-related parameter (F) showed significant differences between the metastatic and non-metastatic groups (p < 0.05). The combination of MTV, SUVmax, and D had the strongest predictive value (area under the ROC 0.983, p < 0.05). SUVmax, SUVmean, and TLG weakly correlated with F (R = − 0.306, − 0.290, and − 0.310; p < 0.05).


The combination of MTV, SUVmax, and D may have a better diagnostic performance than PET- or IVIM-derived parameters either in combination or individually. No strong correlation exists between diffusion parameters and metabolic parameters.

Key Points

• Integrated PET-IVIM MR may assist to characterize lymph node status.

• The combination of MTV, SUV max , and D may have a better diagnostic performance than PET- or IVIM-derived parameters either in combination or individually for the assessment of pelvic lymph nodes with high FDG uptake.

• No strong correlation exists between diffusion parameters and metabolic parameters in pelvic lymph nodes with high FDG uptake.

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Fig. 1
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Fig. 5



Apparent diffusion coefficient


Concurrent chemoradiotherapy


Computed tomography

D :

Diffusion-related coefficient


Perfusion-related diffusion coefficient


Diffusion-weighted imaging

F :

Perfusion-related parameter


The International Federation of Gynecology and Obstetrics


Intravoxel incoherent motion


Magnetic resonance


Metabolic tumor volume


Positron emission tomography/computed tomography


Receiver operating characteristic

SUVmax :

Maximum standardized uptake values

SUVmean :

Mean standardized uptake values


Total lesion glycolysis


Volume of interest


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We would like to thank the native English-speaking scientists of BioMed Proofreading Company for editing our manuscript.


This study has received funding by the National Natural Science Foundation of China (81401438), Liaoning Science & Technology Project (2017225012).

Author information

Correspondence to Hongzan Sun.

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The scientific guarantor of this publication is Hongzan Sun.

Conflict of interest

One of the authors (Chengyan Dong) is an employee of GE Healthcare China. The remaining authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Approved by the Shengjing Hospital of China Medical University Technology ethics committee.


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Xu, C., Du, S., Zhang, S. et al. Value of integrated PET-IVIM MR in assessing metastases in hypermetabolic pelvic lymph nodes in cervical cancer: a multi-parameter study. Eur Radiol (2020).

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  • Cervical cancer
  • Positron emission tomography
  • Diffusion magnetic resonance imaging
  • Lymph node