OBJECTIVE: Our study investigated the effectiveness of using radiomics and non-gadolinium cine cardiac magnetic resonance (CMR) imaging for differential diagnosis between ischemic and dilated cardiomyopathy (ICM vs. DCM) and detecting myocardial scar without relying on gadolinium-based contrast agents. MATERIALS AND METHODS: We retrospectively enrolled 200 patients with age RESULTS: For each of the three models, 21, 14, and 19 radiomic features were selected. The AUC values of each model were 0.964 ± 0.008, 0.989 ± 0.004, and 0.996 ± 0.004, respectively, in the training set and 0.918 ± 0.040, 0.955 ± 0.045, and 0.935 ± 0.052, respectively, in the test set (p <
0.0001). The radiomic models outperformed the radiologist as shown by the ROC curve. CONCLUSIONS: Radiomics showed promise in differentiating between ICM and DCM and detecting myocardial scar with cine CMR images, which offered an alternative for ICM and DCM differentiation in patients with gadolinium contraindication.