<p>Radiomics provides an appealing, non-invasive approach to probing tumor biology for potential diagnostic and prognostic applications. However, its clinical adoption is limited by challenges in interpretability, which in turn compromise its robustness. To uncover the underlying causation, we developed an ultra-large-scale (ULS) computational model that simulates heterogeneous, vascularized tumor growth under physical constraints to a scale that can be visualized in medical images. Our study revealed the pivotal role of tumor proliferation rate in driving necrosis and tissue heterogeneity and the dominant impact of oxygen consumption rate on vascularization level. Analysis of the resultant tumor Radiomics shows a causal relationship between tumor biophysical parameters and imaging features. Specifically, differences in proliferation and oxygen consumption rates result in distinct changes in radiomic image features, identifying suitable imaging modalities and quantitative imaging metrics for studying these biophysical parameters. We thus reverse-engineer the building blocks of Radiomics as a means to understand their respective biological underpinnings. This work introduces what we believe to be the first computational framework that explicitly links tumor cell biology to macroscopic imaging features-an area traditionally explored through radiomics.</p>