Primary mediastinal large B-cell lymphoma (PMBCL) is a rare, aggressive lymphoma affecting young adults. Interim PET/CT (iPET/CT) scans are used to assess treatment response, but the positive predictive value of standard Deauville score remains limited. This retrospective multicenter study analyzed 116 PMBCL patients treated with anthracycline-based chemoimmunotherapy, focusing on 90 patients with high quality iPET/CT. Semiquantitative radiomics metrics, including changes in maximum standardized uptake value (dSUVmax), metabolic tumor volume (dMTV), and total lesion glycolysis (dTLG), were assessed alongside event-free survival (EFS). All interim and final PET/CT scans were independently reviewed by two nuclear medicine physicians blinded to outcomes. Among the 90 patients, 62 (68.9%) were iPET-positive (Deauville scores 4-5). Event-free survival (EFS) at 3 years was significantly higher in iPET-negative patients compared to iPET-positive patients (75% vs. 29%; p < 0.01). Radiomics analysis demonstrated that dSUVmax, dMTV, and dTLG provided superior predictive accuracy for EFS. Values below optimized cut-off thresholds demonstrated significantly better outcomes (e.g., 3-y EFS: 77.8% for dSUVmax ≥ 80% vs. 11.1% for dSUVmax < 80%, p < 0.01). Radiomics-based metrics outperformed visual iPET/CT assessment in identifying high-risk patients, underscoring their potential in guiding treatment. Future research should integrate radiomics with clinical factors to enhance PET-guided treatment strategies.

1st Department of Internal Medicine Hematology 1st Faculty of Medicine Charles University and the General University Hospital Prague Prague Czech Republic

Department of Haemato oncology Faculty of Medicine and Dentistry Palacký University and University Hospital Olomouc Olomouc Czech Republic

Department of Nuclear Medicine Faculty of Medicine and Dentistry Palacký University and University Hospital Olomouc Olomouc Czech Republic

Institute of Nuclear Medicine 1st Faculty of Medicine Charles University and the General University Hospital Prague Prague Czech Republic

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