Cardiac Radiomics Analyses in Times of Photon-counting Computed Tomography for Personalized Risk Stratification in the Present and in the Future.

The need for effective early detection and optimal therapy monitoring of cardiovascular diseases as the leading cause of death has led to an adaptation of the guidelines with a focus on cardiac computed tomography (CCTA) in patients with a low to intermediate risk of coronary heart disease (CHD). In particular, the introduction of photon-counting computed tomography (PCCT) in CT diagnostics promises significant advances through higher temporal and spatial resolution, and also enables advanced texture analysis, known as radiomics analysis. Originally developed in oncological imaging, radiomics analysis is increasingly being used in cardiac imaging and research. The aim is to generate imaging biomarkers that improve the early detection of cardiovascular diseases and therapy monitoring.The present study summarizes the current developments in cardiac CT texture analysis with a particular focus on evaluations of PCCT data sets in different regions, including the myocardium, coronary plaques, and pericoronary/epicardial fat tissue.These developments could revolutionize the diagnosis and treatment of cardiovascular diseases and significantly improve patient prognoses worldwide. The aim of this review article is to shed light on the current state of radiomics research in cardiovascular imaging and to identify opportunities for establishing it in clinical routine in the future. · Radiomics: Enables deeper, objective analysis of cardiovascular structures via feature quantification.. · PCCT: Provides a higher quality image, improving stability and reproducibility in cardiac CT.. · Early detection: PCCT and radiomics enhance cardiovascular disease detection and management.. · Challenges: Technical and standardization issues hinder widespread clinical application.. · Future: Advancing PCCT technologies could soon integrate radiomics in routine practice.. · Ayx I, Bauer R, Schönberg SO et al. Cardiac Radiomics Analyses in Times of Photon-counting Computed Tomography for Personalized Risk Stratification in the Present and in the Future. Rofo 2025; DOI 10.1055/a-2499-3122.