Purpose <p>The main objective of this retrospective study was to investigate the potential role of clinical features and PET/CT imaging intratumoral metabolic heterogeneity (IMH) parameters in predicting the clinical stage of nasopharyngeal carcinoma (NPC).</p> Methods <p>A total of 124 consecutive patients who underwent pretreatment ¹⁸F-FDG PET/CT and were pathologically diagnosed with NPC were retrospectively assessed. Intratumoral metabolic heterogeneity (IMH) parameters were measured and calculated, including the maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), heterogeneity factor (HF), heterogeneity index (HI) and coefficient of variation (COV). To assess the relationship between IMH parameters and NPC clinical stage, T-stage and N-stage status, we constructed clinical prediction models. The diagnostic performance of the model was evaluated using receiver operating characteristic (ROC) curve analysis.</p> Results <p>COV was an independent factor influencing the clinical stage and T stage in NPC. COV was the sole independent factor influencing the clinical stage (stage I &amp; II [early stage] vs. stage III &amp; IV [late stage]) in NPC, with an area under the curve (AUC) of 0.723. Both SUVpeak and COV were independent factors influencing T stage (T1/T2 vs. T3/T4). These factors were used to construct a predictive model that achieved a significant increase in diagnostic efficacy over individual parameter models, yielding an AUC of 0.821.</p> Conclusion <p>IMH parameters derived from PET/CT imaging serve as biomarkers for clinical tumor staging in NPC.</p>