用统计方法验证深度学习看眼底图时,关注部位是否符合医生知识。
Opening the black box of deep learning: Validating the statistical association between explainable artificial intelligence (XAI) and clinical domain knowledge in fundus image-based glaucoma diagnosis
- 用多种注意力热力图技术定位模型关注区域,对比医生认知的解剖结构
- 所有模型在病灶区域的关注度显著高于图像整体占比,且与诊断准确率正相关
- 为临床信任AI诊断提供数据支持,适合医疗AI可解释性研究者参考
尽管深度学习在医学图像任务中表现出色,但其黑箱特性限制了在真实医疗场景中的应用。本研究通过多种类激活图(CAM)技术生成模型关注区域,将其与青光眼诊断中视杯、视盘和血管等解剖结构的临床知识进行比较。采用VGG-11、ResNet-18、DeiT-Tiny和Swin Transformer-Tiny四种神经网络,结合Grad-CAM、XGrad-CAM、Score-CAM、Eigen-CAM和Layer-CAM五种CAM方法,分析模型关注区域中解剖结构的比例。通过配对样本t检验发现,各模型在病灶区域的关注比例均显著高于图像整体占比;皮尔逊与斯皮尔曼相关性检验进一步证实,模型关注区域中解剖结构比例与其预测性能呈正相关。在五个公开青光眼数据集上,结果一致表明深度模型的决策逻辑与医生认知存在统计学上的收敛性。研究为提升临床对AI的信任提供了实证依据,并已将代码与数据发布于GitHub以保障可复现性。
原文摘要 · Abstract (English)
While deep learning has exhibited remarkable predictive capabilities in various medical image tasks, its inherent black-box nature has hindered its widespread implementation in real-world healthcare settings. Our objective is to unveil the decision-making processes of deep learning models in the context of glaucoma classification by employing several Class Activation Map (CAM) techniques to generate model focus regions and comparing them with clinical domain knowledge of the anatomical area (optic cup, optic disk, and blood vessels). Four deep neural networks, including VGG-11, ResNet-18, DeiT-Tiny, and Swin Transformer-Tiny, were developed using binary diagnostic labels of glaucoma and five CAM methods (Grad-CAM, XGrad-CAM, Score-CAM, Eigen-CAM, and Layer-CAM) were employed to highlight the model focus area. We applied the paired-sample t-test to compare the percentage of anatomies in the model focus area to the proportion of anatomies in the entire image. After that, Pearson's and Spearman's correlation tests were implemented to examine the relationship between model predictive ability and the percentage of anatomical structures in the model focus area. On five public glaucoma datasets, all deep learning models consistently displayed statistically significantly higher percentages of anatomical structures in the focus area than the proportions of anatomical structures in the entire image. Also, we validated the positive relationship between the percentage of anatomical structures in the focus area and model predictive performance. Our study provides evidence of the convergence of decision logic between deep neural networks and human clinicians through rigorous statistical tests. We anticipate that it can help alleviate clinicians' concerns regarding the trustworthiness of deep learning in healthcare. For reproducibility, the code and dataset have been released at GitHub.
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