Share:
Share this content in WeChat
X
Review
Advances in metabolic imaging technology for nasopharyngeal carcinoma: From mechanisms to applications
WANG Yulin  REN Huanhuan  ZHANG Jiuquan  LIU Daihong 

Cite this article as: WANG Y L, REN H H, ZHANG J Q, et al. Advances in metabolic imaging technology for nasopharyngeal carcinoma: From mechanisms to applications[J]. Chin J Magn Reson Imaging, 2026, 17(4): 169-174. DOI:10.12015/issn.1674-8034.2026.04.024.


[Abstract] Nasopharyngeal carcinoma is a common head and neck malignancy, which presents clinical challenges including difficulties in early diagnosis and treatment resistance caused by intratumoral spatial heterogeneity. Evidence suggests that the occurrence and development of nasopharyngeal carcinoma are associated with metabolic reprogramming. Metabolic imaging techniques can noninvasively visualize abnormal metabolites to assess intratumoral spatial heterogeneity, offering new tools for early diagnosis, treatment response evaluation, and prognosis prediction in nasopharyngeal carcinoma. In recent years, metabolic imaging techniques have developed rapidly, including 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), hydrogen proton magnetic resonance spectroscopy (1H-MRS), amide proton transfer (APT) imaging, multi-nuclear magnetic resonance imaging and metabolic tracer techniques. However, there is still a lack of systematic integrated analysis of the mechanisms of metabolic reprogramming in nasopharyngeal carcinoma, as well as the application value and limitations of the metabolic imaging techniques. This article will systematically review the above metabolic imaging techniques and their application value from the perspective of metabolic reprogramming, analyze the limitations of current research, and propose future research directions, aiming to provide theoretical basis and technical prospects for enhancing the level of precision diagnosis and treatment of nasopharyngeal carcinoma.
[Keywords] nasopharyngeal carcinoma;metabolic reprogramming;metabolic imaging;multi-nuclear magnetic resonance;diagnosis;treatment response evaluation;prognosis prediction

WANG Yulin1, 2   REN Huanhuan2   ZHANG Jiuquan2*   LIU Daihong2  

1 School of Medicine, Chongqing University, Chongqing 400030, China

2 Department of Radiology, Chongqing University Cancer Hospital, Chongqing 400030, China

Corresponding author: ZHANG J Q, E-mail: zhangjq_radiol@163.com

Conflicts of interest   None.

Received  2026-01-21
Accepted  2026-04-10
DOI: 10.12015/issn.1674-8034.2026.04.024
Cite this article as: WANG Y L, REN H H, ZHANG J Q, et al. Advances in metabolic imaging technology for nasopharyngeal carcinoma: From mechanisms to applications[J]. Chin J Magn Reson Imaging, 2026, 17(4): 169-174. DOI:10.12015/issn.1674-8034.2026.04.024.

[1]
WONG K C W, HUI E P, LO K W, et al. Nasopharyngeal carcinoma: an evolving paradigm[J]. Nat Rev Clin Oncol, 2021, 18(11): 679-695. DOI: 10.1038/s41571-021-00524-x.
[2]
SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. DOI: 10.3322/caac.21660.
[3]
SU Z Y, SIAK P Y, LWIN Y Y, et al. Epidemiology of nasopharyngeal carcinoma: current insights and future outlook[J]. Cancer Metastasis Rev, 2024, 43(3): 919-939. DOI: 10.1007/s10555-024-10176-9.
[4]
WANG L P, WANG D J, ZENG X J, et al. Exploration of spatial heterogeneity of tumor microenvironment in nasopharyngeal carcinoma via transcriptional digital spatial profiling[J]. Int J Biol Sci, 2023, 19(7): 2256-2269. DOI: 10.7150/ijbs.74653.
[5]
LIU H, TANG L, LI Y X, et al. Nasopharyngeal carcinoma: current views on the tumor microenvironment's impact on drug resistance and clinical outcomes[J/OL]. Mol Cancer, 2024, 23(1): 20 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/38254110/. DOI: 10.1186/s12943-023-01928-2.
[6]
XU C, SUN H Z. Clinical application status and development prospects for PET/MR[J]. Chin J Magn Reson Imaging, 2024, 15(7): 7-14, 26. DOI: 10.12015/issn.1674-8034.2024.07.002.
[7]
ZHOU L P, LI T, CAO Y, et al. Multinuclear magnetic resonance imaging in oncology: research progress[J]. Chin J Magn Reson Imaging, 2026, 17(1): 228-234. DOI: 10.12015/issn.1674-8034.2026.01.035.
[8]
RUAN T, KESHARI K R. Imaging tumor metabolism[J]. Cold Spring Harb Perspect Med, 2025, 15(6): a041551. DOI: 10.1101/cshperspect.a041551.
[9]
WEI Y, YANG C W, JIANG H Y, et al. Multi-nuclear magnetic resonance spectroscopy: state of the art and future directions[J/OL]. Insights Imaging, 2022, 13(1): 135 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/35976510. DOI: 10.1186/s13244-022-01262-z.
[10]
LIU Q, BODE A M, CHEN X, et al. Metabolic reprogramming in nasopharyngeal carcinoma: Mechanisms and therapeutic opportunities[J]. Biochim Biophys Acta BBA Rev Cancer, 2023, 1878(6): 189023. DOI: 10.1016/j.bbcan.2023.189023.
[11]
JI L L, WANG D J, ZHUO G Z, et al. Spatial metabolomics and transcriptomics reveal metabolic reprogramming and cellular interactions in nasopharyngeal carcinoma with high PD-1 expression and therapeutic response[J]. Theranostics, 2025, 15(7): 3035-3054. DOI: 10.7150/thno.102822.
[12]
SHI F, SHANG L, ZHOU M, et al. Epstein-Barr virus-driven metabolic alterations contribute to the viral lytic reactivation and tumor progression in nasopharyngeal carcinoma[J/OL]. J Med Virol, 2024, 96(5): e29634 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/38682578. DOI: 10.1002/jmv.29634.
[13]
PAN Z Y, LIU Y Y, LI H, et al. The role and mechanism of aerobic glycolysis in nasopharyngeal carcinoma[J/OL]. PeerJ, 2025, 13: e19213 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/40191756. DOI: 10.7717/peerj.19213.
[14]
HIRATA K, TAMAKI N. Quantitative FDG PET assessment for oncology therapy[J/OL]. Cancers, 2021, 13(4): 869 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/33669531. DOI: 10.3390/cancers13040869.
[15]
LV Y H, ZHENG D Z, WANG R P, et al. Neural network-based automated classification of 18 F-FDG PET/CT lesions and prognosis prediction in nasopharyngeal carcinoma without distant metastasis[J]. Clin Nucl Med, 2025, 50(8): 721-730. DOI: 10.1097/RLU.0000000000005942.
[16]
CHAN S C, NG S H, YEH C H, et al. Prognostic utility of 18F-FDG PET/MRI with intravoxel incoherent motion imaging in nasopharyngeal carcinoma[J]. Eur J Nucl Med Mol Imaging, 2025, 53(1): 338-349. DOI: 10.1007/s00259-025-07425-6.
[17]
HUANG X T, ZHUANG M Z, YANG S, et al. The valuable role of dynamic 18F FDG PET/CT-derived kinetic parameter K i in patients with nasopharyngeal carcinoma prior to radiotherapy: a prospective study[J/OL]. Radiother Oncol, 2023, 179: 109440 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/36566989. DOI: 10.1016/j.radonc.2022.109440.
[18]
YAN W B, LIU T, HE M L, et al. Induction chemotherapy plus re-irradiation versus re-irradiation alone in locally recurrent nasopharyngeal carcinoma: a model-based analysis[J/OL]. Radiother Oncol, 2023, 188: 109903 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/37678621. DOI: 10.1016/j.radonc.2023.109903.
[19]
PENG R R, LIANG Z G, CHEN K H, et al. Nomogram based on lactate dehydrogenase-to-albumin ratio (LAR) and platelet-to-lymphocyte ratio (PLR) for predicting survival in nasopharyngeal carcinoma[J/OL]. J Inflamm Res, 2021, 14: 4019-4033 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/34447260. DOI: 10.2147/JIR.S322475.
[20]
CHANDEL V, MARU S, KUMAR A, et al. Role of monocarboxylate transporters in head and neck squamous cell carcinoma[J/OL]. Life Sci, 2021, 279: 119709 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/34102188. DOI: 10.1016/j.lfs.2021.119709.
[21]
YOU R, SHEN Q L, LIN C, et al. Single-cell and spatial transcriptomics reveal mechanisms of radioresistance and immune escape in recurrent nasopharyngeal carcinoma[J]. Nat Genet, 2025, 57(8): 1950-1965. DOI: 10.1038/s41588-025-02253-8.
[22]
YANG Q, WU F, ZHANG Y, et al. FOXM1 regulates glycolysis in nasopharyngeal carcinoma cells through PDK1[J]. J Cell Mol Med, 2022, 26(13): 3783-3796. DOI: 10.1111/jcmm.17413.
[23]
HVINDEN I C, CADOUX-HUDSON T, SCHOFIELD C J, et al. Metabolic adaptations in cancers expressing isocitrate dehydrogenase mutations[J/OL]. Cell Rep Med, 2021, 2(12): 100469 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/35028610.. DOI: 10.1016/j.xcrm.2021.100469.
[24]
GILL S K, ROSE H E L, WILSON M, et al. Characterisation of paediatric brain tumours by their MRS metabolite profiles[J/OL]. NMR Biomed, 2024, 37(5): e5101 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/38303627. DOI: 10.1002/nbm.5101.
[25]
CHEN Y, CHEN Z, SU Y, et al. Metabolic characteristics revealing cell differentiation of nasopharyngeal carcinoma by combining NMR spectroscopy with Raman spectroscopy[J/OL]. Cancer Cell Int, 2019, 19: 37 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/30820190. DOI: 10.1186/s12935-019-0759-4.
[26]
HUANG H M, LI S S, TANG Q L, et al. Metabolic reprogramming and immune evasion in nasopharyngeal carcinoma[J/OL]. Front Immunol, 2021, 12: 680955 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/34566954. DOI: 10.3389/fimmu.2021.680955.
[27]
LI S Y, LING T, WANG Y H, et al. Glutamine synthetase modulates YAP activation by stabilizing LATS under glutamine homeostasis[J/OL]. Cell Rep, 2025, 44(12): 116620 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/41296569. DOI: 10.1016/j.celrep.2025.116620.
[28]
WANG C C, HWANG T Z, YANG C C, et al. Impact of parenteral glutamine supplement on oncologic outcomes in patients with nasopharyngeal cancer treated with concurrent chemoradiotherapy[J/OL]. Nutrients, 2022, 14(5): 997 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/35267972. DOI: 10.3390/nu14050997.
[29]
SU C, LI M H, YANG Y X, et al. Targeting glutamine metabolism through glutaminase inhibition suppresses cell proliferation and progression in nasopharyngeal carcinoma[J]. Anticancer Agents Med Chem, 2023, 23(17): 1944-1957. DOI: 10.2174/1871520623666230727104825.
[30]
XIONG H, LIU R Q, XU K K, et al. Branched-chain amino acid and cancer: metabolism, immune microenvironment and therapeutic targets[J/OL]. J Transl Med, 2025, 23: 636 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/40495192. DOI: 10.1186/s12967-025-06664-3.
[31]
YEO E L L, HONG B H, TAY S H, et al. Tumor immune microenvironment delineates progression trajectories of distinct nasopharyngeal carcinoma phenotypes[J/OL]. Cell Rep Med, 2025, 6(6): 102143 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/40412382. DOI: 10.1016/j.xcrm.2025.102143.
[32]
YANG Q, ZOU L Y, LIU Z, et al. Preliminary application of amide proton transfer-MRI in diagnosis of nasopharyngeal carcinomas[J]. Chin J Magn Reson Imaging, 2021, 12(9): 6-10. DOI: 10.12015/issn.1674-8034.2021.09.002.
[33]
CHEN X, LI Y X, CAO X, et al. Widely targeted quantitative lipidomics and prognostic model reveal plasma lipid predictors for nasopharyngeal carcinoma[J/OL]. Lipids Health Dis, 2023, 22(1): 81 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/37365637. DOI: 10.1186/s12944-023-01830-2.
[34]
FENG Y Y, WANG H M, ZHU Z Y, et al. Aberrant lipid metabolism reshapes the immune landscape in bone metastasis of nasopharyngeal carcinoma[J/OL]. J Immunother Cancer, 2025, 13(12): e012134 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/41386974. DOI: 10.1136/jitc-2025-012134.
[35]
ZHENG S X, MATSKOVA L, ZHOU X Y, et al. Downregulation of adipose triglyceride lipase by EB viral-encoded LMP2A links lipid accumulation to increased migration in nasopharyngeal carcinoma[J]. Mol Oncol, 2020, 14(12): 3234-3252. DOI: 10.1002/1878-0261.12824.
[36]
CHEN Y T, FENG Y Y, LIN Y L, et al. GSTM3 enhances radiosensitivity of nasopharyngeal carcinoma by promoting radiation-induced ferroptosis through USP14/FASN axis and GPX4[J]. Br J Cancer, 2024, 130(5): 755-768. DOI: 10.1038/s41416-024-02574-1.
[37]
ZARIC O, FARR A, MINARIKOVA L, et al. Tissue sodium concentration quantification at 7.0-T MRI as an early marker for chemotherapy response in breast cancer: a feasibility study[J]. Radiology, 2021, 299(1): 63-72. DOI: 10.1148/radiol.2021201600.
[38]
GAST L V, PLATT T, NAGEL A M, et al. Recent technical developments and clinical research applications of sodium (23Na) MRI[J/OL]. Prog Nucl Magn Reson Spectrosc, 2023, 138/139: 1-51 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/38065665. DOI: 10.1016/j.pnmrs.2023.04.002.
[39]
HU S, YAN S, XIE Y, et al. Test-retest precision of brain metabolites in healthy participants using 31P-MRS and 1H MEGA-PRESS on a 3T multi-nuclear MRI system[J]. Quant Imaging Med Surg, 2025, 15(4): 2852-2864. DOI: 10.21037/qims-24-1853.
[40]
CHEN MING LOW J, WRIGHT A J, HESSE F, et al. Metabolic imaging with deuterium labeled substrates[J/OL]. Prog Nucl Magn Reson Spectrosc, 2023, 134: 39-51 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/37321757. DOI: 10.1016/j.pnmrs.2023.02.002.
[41]
PAN F, LIU X J, WAN J Y, et al. Advances and prospects in deuterium metabolic imaging (DMI): a systematic review of in vivo studies[J/OL]. Eur Radiol Exp, 2024, 8(1): 65 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/38825658. DOI: 10.1186/s41747-024-00464-y.
[42]
IP K L, THOMAS M A, BEHAR K L, et al. Mapping of exogenous choline uptake and metabolism in rat glioblastoma using deuterium metabolic imaging (DMI)[J/OL]. Front Cell Neurosci, 2023, 17: 1130816 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/37187610. DOI: 10.3389/fncel.2023.1130816.
[43]
NIESS F, HINGERL L, STRASSER B, et al. Noninvasive 3-dimensional 1 H-magnetic resonance spectroscopic imaging of human brain glucose and neurotransmitter metabolism using deuterium labeling at 3T: feasibility and interscanner reproducibility[J]. Invest Radiol, 2023, 58(6): 431-437. DOI: 10.1097/RLI.0000000000000953.
[44]
LIU Y N, DE FEYTER H M, CORBIN Z A, et al. Parallel detection of multi-contrast MRI and Deuterium Metabolic Imaging (DMI) for time-efficient characterization of neurological diseases[J/OL]. medRxiv, 2023: 2023.10.02.23296408 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/40197096. DOI: 10.1101/2023.10.02.23296408.
[45]
JANSEN J F, SCHÖDER H, LEE N Y, et al. Tumor metabolism and perfusion in head and neck squamous cell carcinoma: pretreatment multimodality imaging with 1H magnetic resonance spectroscopy, dynamic contrast-enhanced MRI, and [18F] FDG-PET[J]. Int J Radiat Oncol Biol Phys, 2012, 82(1): 299-307. DOI: 10.1016/j.ijrobp.2010.11.022.
[46]
LAW B K H, KING A D, AI Q Y, et al. Head and neck tumors: amide proton transfer MRI[J]. Radiology, 2018, 288(3): 782-790. DOI: 10.1148/radiol.2018171528.
[47]
THAW-POON S, BLONDIN N A, LIU Y N, et al. Nimg-30. deuterium metabolic imaging (dmi) shows a strong relation between tumor grade and glucose metabolism in primary brain tumors[J/OL]. Neuro Oncol, 2024, 26(Supplement_8): viii201 [2026-01-26]. https://doi.org/10.1093/neuonc/noae165.0795. DOI: 10.1093/neuonc/noae165.0795.
[48]
SMITH T, CHAU M, SIMS J, et al. 23Na-MRI for breast cancer diagnosis and treatment monitoring: a scoping review[J/OL]. Bioengineering (Basel), 2025, 12(2): 158. [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/40001678. DOI: 10.3390/bioengineering12020158.
[49]
CHO H, KIM S H, KIM H, et al. Lymph node with the highest FDG uptake predicts distant metastasis-free survival in patients with locally advanced nasopharyngeal carcinoma[J/OL]. Clin Nucl Med, 2018, 43(7): e220-e225 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/29762247. DOI: 10.1097/RLU.0000000000002145.
[50]
GU L W, LI Y C, XUE S Y, et al. Integrating pretreatment 18F-FDG PET-CT parameters, peripheral blood indicators and clinical characteristics in predicting chemotherapy plus immunotherapy outcomes for de novo metastatic nasopharyngeal carcinoma[J]. Rhinology, 2025, 63(3): 363-372. DOI: 10.4193/Rhin24.547.
[51]
QAMAR S, KING A D, AI Q H, et al. Pre-treatment amide proton transfer imaging predicts treatment outcome in nasopharyngeal carcinoma[J]. Eur Radiol, 2020, 30(11): 6339-6347. DOI: 10.1007/s00330-020-06985-5.
[52]
LIU W G, WANG X, XIE S M, et al. Amide proton transfer (APT) and magnetization transfer (MT) in predicting short-term therapeutic outcome in nasopharyngeal carcinoma after chemoradiotherapy: a feasibility study of three-dimensional chemical exchange saturation transfer (CEST) MRI[J/OL]. Cancer Imaging, 2023, 23(1): 80 [2026-01-26]. https://pubmed.ncbi.nlm.nih.gov/37658446. DOI: 10.1186/s40644-023-00602-6.
[53]
CHO N, IM S A, KANG K W, et al. Early prediction of response to neoadjuvant chemotherapy in breast cancer patients: comparison of single-voxel 1H-magnetic resonance spectroscopy and 18F-fluorodeoxyglucose positron emission tomography[J]. Eur Radiol, 2016, 26(7): 2279-2290. DOI: 10.1007/s00330-015-4014-7.

PREV Research progress of magnetic resonance imaging technology in the assessment of blood-spinal cord barrier disruption
NEXT Research advances in CMR for mitral valve apparatus abnormalities in hypertrophic cardiomyopathy
  



Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn