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To investigate if the combined analysis of the apparent diffusion coefficient (ADC) and standardized uptake values (SUV) measured in 18 F-fluoro-deoxy-glucose-positron emission tomography/magnetic resonance imaging ( 18 F-FDG PET/MRI) examinations correlates with overall survival in non-small cell lung cancer (NSCLC). Material and methods: A total of 92 patients with newly diagnosed, histopathologically proven NSCLC (44 women and 48 men, mean age 63.1 ± 9.9y) underwent a dedicated thoracic 18 F-FDG PET/MRI examination. A manually drawn polygonal region of interest (ROI), encompassing the entire primary tumor mass, was placed over the primary tumor on fused PET/MR images to determine the maximum and mean standardized uptake values (SUV max ; SUV mean ) as well as on the ADC maps to quantify the mean and minimum ADC values (ADC mean , ADC min ). The impact of these parameters to predict patient's overall survival was tested using hazard ratios (HR). Pearson's correlation coefficients were calculated to assess dependencies between the different values. A p-value < 0.05 indicated statistical significance. Results: In all 92 patients (n = 59 dead at time of retrospective data collection, mean time till death: 19 ± 16 month, n = 33 alive, mean time to last follow-up: 56 ± 22 month) the Hazard ratios (HR) as independent predictors for overall survival (OS) of SUV max were 2.37 (95 % CI: 1.23-4.59, p = 0.008) and for SUV mean 1.85 (95 % CI: 1.05-3.26, p = 0.03) while ADC min showed a HR of 0.95 (95 % CI: 0.57-1.59, p = 0.842) and ADC mean a HR of 2.01 (95 % CI: 1.2-3.38, p = 0.007). Furthermore, a combined analysis for SUV max /ADC mean , SUV max / ADC min and SUV mean /ADC mean revealed a HR of 2.01 (95 % CI: 1.10-3.67, p = 0.02), 1.75 (95 % CI: 0.97-3.15, p = 0.058) and 1.78 (95 % CI: 1.02-3.10, p = 0.04). Conclusion: SUV max and SUV mean of the primary tumor are predictors for OS in therapy-naive NSCLC patients, whereas the combined analysis of SUV and ADC values does not improve these results. Therefore, ADC values do not further enhance the diagnostic value of SUV as a prognostic biomarker in NSCLC.

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