The clinical implications and interpretability of computational medical imaging (radiomics) in brain tumors

Radiomics has widespread applications in the field of brain tumor research. However, radiomic analyses often function as a 'black box' due to their use of complex algorithms, which hinders the translation of brain tumor radiomics into clinical applications. In this review, we will elaborate extensively on the application of radiomics in brain tumors. Additionally, we will address the interpretability of handcrafted-feature radiomics and deep learning-based radiomics by integrating biological domain knowledge of brain tumors with interpretability methods. Furthermore, we will discuss the current challenges and prospects concerning the interpretability of brain tumor radiomics. Enhancing the interpretability of radiomics may make it more understandable for physicians, ultimately facilitating its translation into clinical practice. CRITICAL RELEVANCE STATEMENT: The interpretability of brain tumor radiomics empowers neuro-oncologists to make well-informed decisions from radiomic models. KEY POINTS: Radiomics makes a significant impact on the management of brain tumors in several key clinical areas. Transparent models, habitat analysis, and feature attribute explanations can enhance the interpretability of traditional handcrafted-feature radiomics in brain tumors. Various interpretability methods have been applied to explain deep learning-based models; however, there is a lack of biological mechanisms underlying these models.