Purpose To correlate the overall survival (OS) with the imaging biomarkers of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy, and glucose metabolic activity derived from integrated fluorine 18 fluorodeoxyglucose positron emission tomography ( 18 F–FDG PET)/MRI in patients with pancreatic cancer. Methods This prospective study was approved by the institutional review board and informed consent was obtained from all participants. Sixty-three consecutive patients (mean age, 62.7 ± 12 y; men/women, 40/23) with pancreatic cancer underwent PET/MRI before treatment. The imaging biomarkers were comprised of DCE-MRI parameters ( peak, IAUC 60 , K trans , k ep , v e ), the minimum apparent diffusion coefficient (ADC min ), choline level, standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) of the tumors. The relationships between these imaging biomarkers with OS were evaluated with the Kaplan-Meier and Cox proportional hazard models. Results Seventeen (27%) patients received curative surgery, with the median follow-up duration being 638 days. Univariate analysis showed that patients at a low TNM stage (≦3, P  = 0.041), high peak ( P  = 0.006), high ADC min ( P  = 0.002) and low TLG ( P  = 0.01) had better OS. Moreover, high TLG/ peak ratio was associated with poor OS ( P  = 0.016). Multivariate analysis indicated that ADC min ( P  = 0.011) and TLG/ peak ratio ( P  = 0.006) were independent predictors of OS after adjustment for age, gender, tumor size, and TNM stage. The TLG/ peak ratio was an independent predictor of OS in a subgroup of patients who did not receive curative surgery ( P  = 0.013). Conclusion The flow-metabolism mismatch reflected by the TLG/ peak ratio may better predict OS than other imaging biomarkers from PET/MRI in pancreatic cancer patients.