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Scans with multi <jats:italic>b<\/jats:italic>-values (0\u20131500\u2009s\/mm<jats:sup>2<\/jats:sup>) and multi-echo times (7\u2013150\u2009ms) were performed to generate normalized diffusion-T2 spectra. Tumor maximal diameter and depth of invasion were measured. Tumors were segmented into five compartments (<jats:italic>V<\/jats:italic>\n              <jats:sub>A<\/jats:sub> to <jats:italic>V<\/jats:italic>\n              <jats:sub>E<\/jats:sub>) with metrics compared across normal controls, CLNM-, and CLNM+ groups. Pathological parameters such as tumor-stroma ratio (TSR), perineural invasion, Ki-67, tumor p53 protein, and cyclin-dependent kinase inhibitor p16 were evaluated. Correlations between MRI metrics and pathological parameters were assessed. Predictors of CLNM+ were identified using logistic regression analysis, and the predictive performance was evaluated using receiver operating characteristic analysis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Thirty-four patients were assigned to the CLNM+ group and 23 to the CLNM- group. CLNM+ patients showed larger tumor maximal diameters, deeper invasion, increased <jats:italic>V<\/jats:italic>\n              <jats:sub>B<\/jats:sub> and <jats:italic>V<\/jats:italic>\n              <jats:sub>D<\/jats:sub>, and decreased <jats:italic>V<\/jats:italic>\n              <jats:sub>A<\/jats:sub> compared to CLNM- patients. <jats:italic>V<\/jats:italic>\n              <jats:sub>B<\/jats:sub> exhibited strong positive correlations with perineural invasion and depth of invasion, while <jats:italic>V<\/jats:italic>\n              <jats:sub>D<\/jats:sub> correlated positively with TSR. Moreover, <jats:italic>V<\/jats:italic>\n              <jats:sub>B<\/jats:sub> and depth of invasion were independent prognostic factors for CLNM+, and their combined model achieved the highest predictive performance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Diffusion-relaxation correlation spectroscopic imaging marked a significant advancement in the diagnostic and prognostic assessment of OTSCC, offering detailed tumor characterization and improving CLNM+ prediction, with great potential for accurate and non-invasive evaluation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Relevance statement<\/jats:title>\n            <jats:p>Diffusion-relaxation correlation spectroscopic imaging metrics (<jats:italic>V<\/jats:italic>\n              <jats:sub>B<\/jats:sub> and <jats:italic>V<\/jats:italic>\n              <jats:sub>D<\/jats:sub>) characterized tumor heterogeneity and correlated with pathological biomarkers, making it a promising non-invasive tool for enhancing preoperative decisions and reducing unnecessary lymph node dissections in clinical workflows.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Key Points<\/jats:title>\n            <jats:p>\n              <jats:list list-type=\"bullet\">\n                <jats:list-item>\n                  <jats:p>Tumoral components and heterogeneity of oral tongue cancer were investigated on MRI.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>Advanced diffusion-relaxation imaging delineated the tumoral differential profile and predicted metastasis.<\/jats:p>\n                <\/jats:list-item>\n                <jats:list-item>\n                  <jats:p>We provided a non-invasive tool for preoperative decision-making in clinical workflows.<\/jats:p>\n                <\/jats:list-item>\n              <\/jats:list>\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical Abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1186\/s41747-025-00639-1","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T04:04:32Z","timestamp":1759896272000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Advanced diffusion-relaxation imaging for tumoral differentiation and metastasis prediction in oral tongue cancer"],"prefix":"10.1186","volume":"9","author":[{"given":"Siyu","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wentao","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gongxin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofeng","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yifeng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongmei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingwei","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6084-9685","authenticated-orcid":false,"given":"Yongming","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"639_CR1","doi-asserted-by":"publisher","first-page":"401","DOI":"10.3322\/caac.21293","volume":"65","author":"AC Chi","year":"2015","unstructured":"Chi AC, Day TA, Neville BW (2015) Oral cavity and oropharyngeal squamous cell carcinoma\u2013an update. 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