| Summary: | Background: The aim of this study is to explore the utility of cardiac magnetic resonance (CMR) imaging of radiomic features to distinguish active and inactive cardiac sarcoidosis (CS). Methods: Subjects were classified into active cardiac sarcoidosis (CS<sub>active</sub>) and inactive cardiac sarcoidosis (CS<sub>inactive</sub>) based on PET-CMR imaging. CS<sub>active</sub> was classified as featuring patchy [<sup>18</sup>F]fluorodeoxyglucose ([<sup>18</sup>F]FDG) uptake on PET and presence of late gadolinium enhancement (LGE) on CMR, while CS<sub>inactive</sub> was classified as featuring no [<sup>18</sup>F]FDG uptake in the presence of LGE on CMR. Among those screened, thirty CS<sub>active</sub> and thirty-one CS<sub>inactive</sub> patients met these criteria. A total of 94 radiomic features were subsequently extracted using PyRadiomics. The values of individual features were compared between CS<sub>active</sub> and CS<sub>inactive</sub> using the Mann–Whitney U test. Subsequently, machine learning (ML) approaches were tested. ML was applied to two sub-sets of radiomic features (signatures A and B) that were selected by logistic regression and PCA, respectively. Results: Univariate analysis of individual features showed no significant differences. Of all features, gray level co-occurrence matrix (GLCM) joint entropy had a good area under the curve (AUC) and accuracy with the smallest confidence interval, suggesting it may be a good target for further investigation. Some ML classifiers achieved reasonable discrimination between CS<sub>active</sub> and CS<sub>inactive</sub> patients. With signature A, support vector machine and k-neighbors showed good performance with AUC (0.77 and 0.73) and accuracy (0.67 and 0.72), respectively. With signature B, decision tree demonstrated AUC and accuracy around 0.7; Conclusion: CMR radiomic analysis in CS provides promising results to distinguish patients with active and inactive disease.
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