arXiv:2504.06299eess.IVcs.CV2025-04中稿 · MICCAI 2026被引 1

用多模态模型预测中风后三个月功能独立性,兼顾高精度与可解释性。

Explainability in mulimodal deep transformation models for stroke outcome prediction

  • 结合统计方法与3D CNN的深层转换模型,提升图像与临床数据融合能力。
  • 在407名患者上实现AUC 0.81,年龄和入院时中风严重程度为关键预测因子。
  • 首次将Grad-CAM与遮挡法用于该模型,生成脑区解释图并验证病理机制。

基于影像与临床数据的多模态预测模型在临床决策支持中日益重要,但其可解释性仍受限。本文提出多模态深层转换模型(DTMs),融合统计方法与神经网络,在保持表格数据可解释性的同时实现强预测性能。核心贡献是将xAI方法Grad-CAM与遮挡法应用于依赖3D CNN的图像分支,生成解释图以解析影像部分。研究基于407名患者的弥散加权成像和临床数据,预测中风后三个月的功能独立性。十折交叉验证显示模型达到AUC 0.81(95% CI: 0.75–0.87)的最先进性能,且表格特征保持可解释性;入院前功能独立状态与中风严重程度为最强预测因子。两种xAI方法生成的解释图揭示一致脑区(如额叶),这些区域与年龄相关,而年龄本身是功能结局的重要预测因子。当年龄作为显式表格变量加入后,对应解释图消失,表明模型能区分协变量影响。解释图的空间模式差异分析揭示了中风病理生理学线索、系统性误差来源,并可用于生成新假设。

原文摘要 · Abstract (English)

Multimodal prediction models based on imaging and clinical data are increasingly used for clinical decision support, yet their interpretability remains limited. We present multimodal Deep Transformation Models (DTMs) combining statistical approaches and neural networks to achieve strong predictive performance while preserving interpretability for tabular data. A key contribution of this work is the adaption of the xAI methods Grad-CAM and Occlusion to DTMs relying on 3D CNNs, enabling interpretation of the image branch through the generation of explanation maps. We developed DTMs to predict functional independence three months after stroke using diffusion-weighted imaging and clinical data from 407 patients. In a ten-fold cross-validation, the models achieved state-of-the-art predictive performance (AUC 0.81 [0.75, 0.87]) while maintaining interpretability for tabular features, with functional independence before stroke and stroke severity on admission emerging as the strongest predictors. Explanation maps from both xAI methods highlighted consistent regions, including frontal lobe areas which are known to be associated with age, a strong predictor of functional outcome. Notably, these regions disappeared once age was included as an explicit tabular predictor. Similarity analyses of explanation maps revealed distinct spatial patterns, providing meaningful insights into stroke pathophysiology, systematic error analysis and hypothesis generation.

中风预测可解释性多模态深度学习

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