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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleORIGINAL RESEARCH

FDG-PET intensity normalization improves radiomics- based survival prediction in oropharyngeal cancer patients: a comparison of the SUV with alternative normalization techniques

Seyedmehdi Payabvash, Kariem Sharaf, Tal Zeevi, Moritz Gross, Amit Mahajan, Benjamin H. Kann, Benjamin L. Judson, Andrea Schreier, Jasmin Krenn, Manju L. Prasad, Barbara Burtness, Mariam Aboian, Martin Canis, Philipp Baumeister, Christoph A. Reichel and Stefan P. Haider
American Journal of Neuroradiology May 2025, ajnr.A8836; DOI: https://doi.org/10.3174/ajnr.A8836
Seyedmehdi Payabvash
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Kariem Sharaf
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Tal Zeevi
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Moritz Gross
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Amit Mahajan
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Benjamin H. Kann
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Benjamin L. Judson
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Andrea Schreier
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Jasmin Krenn
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Manju L. Prasad
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Barbara Burtness
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Mariam Aboian
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Martin Canis
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Philipp Baumeister
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Christoph A. Reichel
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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Stefan P. Haider
From the Department of Radiology, Columbia University Medical Center, New York, NY, USA (Seyedmehdi Payabvash, MD), Department of Otorhinolaryngology, LMU Clinic of Ludwig-Maximilians-University of Munich, Munich, Germany (Kariem Sharaf, MD, DDS; Andrea Schreier, MD; Jasmin Krenn; Martin Canis, MD; Philipp Baumeister, MD; Christoph A. Reichel, MD; Stefan P. Haider, MD), Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA (Tal Zeevi, MSc; Moritz Gross; Amit Mahajan, MD; Stefan P. Haider, MD), Charité Center for Diagnostic and Interventional Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany (Moritz Gross), Department of Radiation Oncology, Dana-Farber- Cancer-Institute, Harvard Medical School, Boston, MA, USA (Benjamin H. Kann, MD), Division of Otolaryngology, Yale School of Medicine, New Haven, CT, USA (Benjamin L. Judson, MD), Department of Pathology, Yale School of Medicine, New Haven, CT, USA (Manju L. Prasad, MD), Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA (Barbara Burtness, MD), Bavarian Cancer Research Center (BZKF), Munich, Germany (Philipp Baumeister, MD), and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA (Mariam Aboian, MD/PhD).
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ABSTRACT

BACKGROUND AND PURPOSE: Despite the widespread research application of radiomics, there is a knowledge gap regarding the optimal voxel intensity normalization strategy for FDG-PET radiomics. We investigated the impact of three normalization strategies on the prognostic utility of individual radiomic features and machine learning models in oropharyngeal squamous cell carcinoma (OPSCC) patients.

MATERIALS AND METHODS: We included n=330 (overall survival, OS, study group), n=335 (progression-free survival, PFS, study group) and n=309 (locoregional progression, LRP, study group) OPSCC patients. Three FDG-PET intensity normalization strategies were applied: the conventional body weight-corrected Standardized Uptake Value (SUV), and standardized uptake ratios to the lentiform nucleus and to the cerebellum. The raw PET voxel intensities were also analyzed. To quantify and compare features’ association with oncologic outcome, we fitted univariate Cox regression models, calculated Harrell’s C-index, and fitted random survival forest (RSF) machine learning algorithms.

RESULTS: All normalization strategies tended to improve the prognostic value of radiomic features. Features from lentiform nucleus- normalized PET demonstrated the highest prognostic improvement, with n=750/1037, n=809/1037 and n=652/1037 primary tumor features attaining a significant association with OS, PFS, and LRP, respectively, compared to n=0, n=211, and n=1 SUV-based PET features, respectively. The median C-index of lentiform nucleus-normalized PET features was 0.64, 0.61 and 0.62 for OS, PFS, and LRP, respectively, while SUV-based PET features reached 0.59, 0.58 and 0.60, respectively. The best performing lentiform nucleus- normalization RSF model significantly outperformed the raw PET RSF model in predicting OS (C-index=0.66 vs. C-index=0.57; p=0.019), with model comparisons for PFS and LRP approaching statistical significance (p=0.053 and p=0.084, respectively). In contrast, the best performing SUV-based RSF models were not significantly different from raw PET models.

CONCLUSIONS: Normalizing PET intensities, especially to the lentiform nucleus, improves the prognostic performance of individual radiomic features and machine learning models in predicting oncologic outcome.

ABBREVIATIONS: FDG-PET = [18F]fluorodeoxyglucose positron emission tomography; SUV = standardized uptake value; OPSCC = oropharyngeal squamous cell carcinoma; HPV = human papillomavirus; VOI = volume of interest; OS = overall survival; PFS = progression-free survival; LRP = locoregional progression; C-index = Harrell’s concordance index; RSF = random survival forest; CV = cross-validation; AUC = area under the curve; SD = standard deviation.

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  • The authors declare no conflicts of interest related to the content of this article.

  • © 2025 by American Journal of Neuroradiology

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Seyedmehdi Payabvash, Kariem Sharaf, Tal Zeevi, Moritz Gross, Amit Mahajan, Benjamin H. Kann, Benjamin L. Judson, Andrea Schreier, Jasmin Krenn, Manju L. Prasad, Barbara Burtness, Mariam Aboian, Martin Canis, Philipp Baumeister, Christoph A. Reichel, Stefan P. Haider
FDG-PET intensity normalization improves radiomics- based survival prediction in oropharyngeal cancer patients: a comparison of the SUV with alternative normalization techniques
American Journal of Neuroradiology May 2025, ajnr.A8836; DOI: 10.3174/ajnr.A8836

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Accepted Manuscript
FDG-PET intensity normalization improves radiomics- based survival prediction in oropharyngeal cancer patients: a comparison of the SUV with alternative normalization techniques
Seyedmehdi Payabvash, Kariem Sharaf, Tal Zeevi, Moritz Gross, Amit Mahajan, Benjamin H. Kann, Benjamin L. Judson, Andrea Schreier, Jasmin Krenn, Manju L. Prasad, Barbara Burtness, Mariam Aboian, Martin Canis, Philipp Baumeister, Christoph A. Reichel, Stefan P. Haider
American Journal of Neuroradiology May 2025, ajnr.A8836; DOI: 10.3174/ajnr.A8836
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