Explainable, Multi-modal Wound Infection Classification from Images Augmented with Generated Captions

Infections in Diabetic Foot Ulcers (DFUs) can cause severe complications, including tissue death and limb amputation, highlighting the need for accurate, timely diagnosis. Previous machine learning methods have focused on identifying infections by analyzing wound images alone, without utilizing additional metadata such as medical notes. In this study, we aim to improve infection detection by introducing Synthetic Caption Augmented Retrieval for Wound Infection Detection (SCARWID), a novel deep learning framework that leverages synthetic textual descriptions to augment DFU images. SCARWID consists of two components: (1) Wound-BLIP, a Vision-Language Model (VLM) fine-tuned on GPT-4o-generated descriptions to synthesize consistent captions from images; and (2) an Image-Text Fusion module that uses cross-attention to extract cross-modal embeddings from an image and its corresponding Wound-BLIP caption. Infection status is determined by retrieving the top-k similar items from a labeled support set. To enhance the diversity of training data, we utilized a latent diffusion model to generate additional wound images. As a result, SCARWID outperformed state-of-the-art models, achieving average sensitivity, specificity, and accuracy of 0.85, 0.78, and 0.81, respectively, for wound infection classification. Displaying the generated captions alongside the wound images and infection detection results enhances interpretability and trust, enabling nurses to align SCARWID outputs with their medical knowledge. This is particularly valuable when wound notes are unavailable or when assisting novice nurses who may find it difficult to identify visual attributes of wound infection.

Guided Conditional Diffusion Classifier (ConDiff) for Enhanced Prediction of Infection in Diabetic Foot Ulcers

To detect infected wounds in Diabetic Foot Ulcers (DFUs) from photographs, preventing severe complications and amputations. Methods: This paper proposes the Guided Conditional Diffusion Classifier (ConDiff), a novel deep-learning infection detection model that combines guided image synthesis with a denoising diffusion model and distance-based classification. The process involves (1) generating guided conditional synthetic images by injecting Gaussian noise to a guide image, followed by denoising the noise-perturbed image through a reverse diffusion process, conditioned on infection status and (2) classifying infections based on the minimum Euclidean distance between synthesized images and the original guide image in embedding space. Results: ConDiff demonstrated superior performance with an accuracy of 83% and an F1-score of 0.858, outperforming state-of-the-art models by at least 3%. The use of a triplet loss function reduces overfitting in the distance-based classifier. Conclusions: ConDiff not only enhances diagnostic accuracy for DFU infections but also pioneers the use of generative discriminative models for detailed medical image analysis, offering a promising approach for improving patient outcomes.