MiMICRI: Towards Domain-centered Counterfactual Explanations of Cardiovascular Image Classification Models

The recent prevalence of publicly accessible, large medical imaging datasets has led to a proliferation of artificial intelligence (AI) models for cardiovascular image classification and analysis. At the same time, the potentially significant impacts of these models have motivated the development of a range of explainable AI (XAI) methods that aim to explain model predictions given certain image inputs. However, many of these methods are not developed or evaluated with domain experts, and explanations are not contextualized in terms of medical expertise or domain knowledge. In this paper, we propose a novel framework and python library, MiMICRI, that provides domain-centered counterfactual explanations of cardiovascular image classification models. MiMICRI helps users interactively select and replace segments of medical images that correspond to morphological structures. From the counterfactuals generated, users can then assess the influence of each segment on model predictions, and validate the model against known medical facts. We evaluate this library with two medical experts. Our evaluation demonstrates that a domain-centered XAI approach can enhance the interpretability of model explanations, and help experts reason about models in terms of relevant domain knowledge. However, concerns were also surfaced about the clinical plausibility of the counterfactuals generated. We conclude with a discussion on the generalizability and trustworthiness of the MiMICRI framework, as well as the implications of our findings on the development of domain-centered XAI methods for model interpretability in healthcare contexts.

Unsupervised Domain Adaptation from Axial to Short-Axis Multi-Slice Cardiac MR Images by Incorporating Pretrained Task Networks

Anisotropic multi-slice Cardiac Magnetic Resonance (CMR) Images are conventionally acquired in patient-specific short-axis (SAX) orientation. In specific cardiovascular diseases that affect right ventricular (RV) morphology, acquisitions in standard axial (AX) orientation are preferred by some investigators, due to potential superiority in RV volume measurement for treatment planning. Unfortunately, due to the rare occurrence of these diseases, data in this domain is scarce. Recent research in deep learning-based methods mainly focused on SAX CMR images and they had proven to be very successful. In this work, we show that there is a considerable domain shift between AX and SAX images, and therefore, direct application of existing models yield sub-optimal results on AX samples. We propose a novel unsupervised domain adaptation approach, which uses task-related probabilities in an attention mechanism. Beyond that, cycle consistency is imposed on the learned patient-individual 3D rigid transformation to improve stability when automatically re-sampling the AX images to SAX orientations. The network was trained on 122 registered 3D AX-SAX CMR volume pairs from a multi-centric patient cohort. A mean 3D Dice of $0.86\pm{0.06}$ for the left ventricle, $0.65\pm{0.08}$ for the myocardium, and $0.77\pm{0.10}$ for the right ventricle could be achieved. This is an improvement of $25\%$ in Dice for RV in comparison to direct application on axial slices. To conclude, our pre-trained task module has neither seen CMR images nor labels from the target domain, but is able to segment them after the domain gap is reduced. Code: https://github.com/Cardio-AI/3d-mri-domain-adaptation

How well do U-Net-based segmentation trained on adult cardiac magnetic resonance imaging data generalise to rare congenital heart diseases for surgical planning?

Planning the optimal time of intervention for pulmonary valve replacement surgery in patients with the congenital heart disease Tetralogy of Fallot (TOF) is mainly based on ventricular volume and function according to current guidelines. Both of these two biomarkers are most reliably assessed by segmentation of 3D cardiac magnetic resonance (CMR) images. In several grand challenges in the last years, U-Net architectures have shown impressive results on the provided data. However, in clinical practice, data sets are more diverse considering individual pathologies and image properties derived from different scanner properties. Additionally, specific training data for complex rare diseases like TOF is scarce. For this work, 1) we assessed the accuracy gap when using a publicly available labelled data set (the Automatic Cardiac Diagnosis Challenge (ACDC) data set) for training and subsequent applying it to CMR data of TOF patients and vice versa and 2) whether we can achieve similar results when applying the model to a more heterogeneous data base. Multiple deep learning models were trained with four-fold cross validation. Afterwards they were evaluated on the respective unseen CMR images from the other collection. Our results confirm that current deep learning models can achieve excellent results (left ventricle dice of $0.951\pm{0.003}$/$0.941\pm{0.007}$ train/validation) within a single data collection. But once they are applied to other pathologies, it becomes apparent how much they overfit to the training pathologies (dice score drops between $0.072\pm{0.001}$ for the left and $0.165\pm{0.001}$ for the right ventricle).