Radiomics Feature Stability in True and Virtual Non-Contrast Reconstructions from Cardiac Photon-Counting Detector CT Datasets

: Virtual non-contrast (VNC) series reconstructed from contrast-enhanced cardiac scans acquired with photon counting detector CT (PCD-CT) systems have the potential to replace true non-contrast (TNC) series. However, a quantitative comparison of the image characteristics of TNC and VNC data is necessary to determine to what extent they are interchangeable. This work quantitatively evaluates the image similarity between VNC and TNC reconstructions by measuring the stability of multi-class radiomics features extracted in intra-patient TNC and VNC reconstructions. : TNC and VNC series of 84 patients were retrospectively collected. For each patient, the myocardium and epicardial adipose tissue (EAT) were semi-automatically segmented in both VNC and TNC reconstructions, and 105 radiomics features were extracted in each mask. Intra-feature correlation scores were computed using the intraclass correlation coefficient (ICC). Stable features were defined with an ICC higher than 0.75. : In the myocardium, 41 stable features were identified, and the three with the highest ICC were glrlm_GrayLevelVariance with ICC3 of 0.98 [0.97, 0.99], ngtdm_Strength with ICC3 of 0.97 [0.95, 0.98], firstorder_Variance with ICC3 of 0.96 [0.94, 0.98]. For the epicardial fat, 40 stable features were found, and the three highest ranked are firstorder_Median with ICC3 of 0.96 [0.93, 0.97], firstorder_RootMeanSquared with ICC3 of 0.95 [0.92, 0.97], firstorder_Mean with ICC3 of 0.95 [0.92, 0.97]. A total of 24 features (22.8%; 24/105) showed stability in both anatomical structures. : The significant differences in the correlation of radiomics features in VNC and TNC volumes of the myocardium and epicardial fat suggested that the two reconstructions may differ more than initially assumed. This indicates that they may not be interchangeable, and such differences could have clinical implications. Therefore, care should be given when selecting VNC as a substitute for TNC in radiomics research to ensure accurate and reliable analysis. Moreover, the observed variations may impact clinical workflows, where precise tissue characterization is critical for diagnosis and treatment planning.