Christian Tinauer

Christian Tinauer, Anna Damulina, Maximilian Sackl et al.

Motivation. While recent studies show high accuracy in the classification of Alzheimer's disease using deep neural networks, the underlying learned concepts have not been investigated. Goals. To systematically identify changes in brain regions through concepts learned by the deep neural network for model validation. Approach. Using quantitative R2* maps we separated Alzheimer's patients (n=117) from normal controls (n=219) by using a convolutional neural network and systematically investigated the learned concepts using Concept Relevance Propagation and compared these results to a conventional region of interest-based analysis. Results. In line with established histological findings and the region of interest-based analyses, highly relevant concepts were primarily found in and adjacent to the basal ganglia. Impact. The identification of concepts learned by deep neural networks for disease classification enables validation of the models and could potentially improve reliability.

Christian Tinauer, Maximilian Sackl, Stefan Ropele et al.

Deep learning models have shown strong performance in classifying Alzheimer's disease (AD) from R2* maps, but their decision-making remains opaque, raising concerns about interpretability. Previous studies suggest biases in model decisions, necessitating further analysis. This study uses Layer-wise Relevance Propagation (LRP) and spectral clustering to explore classifier decision strategies across preprocessing and training configurations using R2* maps. We trained a 3D convolutional neural network on R2* maps, generating relevance heatmaps via LRP and applied spectral clustering to identify dominant patterns. t-Stochastic Neighbor Embedding (t-SNE) visualization was used to assess clustering structure. Spectral clustering revealed distinct decision patterns, with the relevance-guided model showing the clearest separation between AD and normal control (NC) cases. The t-SNE visualization confirmed that this model aligned heatmap groupings with the underlying subject groups. Our findings highlight the significant impact of preprocessing and training choices on deep learning models trained on R2* maps, even with similar performance metrics. Spectral clustering offers a structured method to identify classification strategy differences, emphasizing the importance of explainability in medical AI.

Christian Tinauer, Maximilian Sackl, Rudolf Stollberger et al.

Objectives: High classification accuracy of Alzheimer's disease (AD) from structural MRI has been achieved using deep neural networks, yet the specific image features contributing to these decisions remain unclear. In this study, the contributions of T1-weighted (T1w) gray-white matter texture, volumetric information, and preprocessing -- particularly skull-stripping -- were systematically assessed. Methods: A dataset of 990 matched T1w MRIs from AD patients and cognitively normal controls from the ADNI database were used. Preprocessing was varied through skull-stripping and intensity binarization to isolate texture and shape contributions. A 3D convolutional neural network was trained on each configuration, and classification performance was compared using exact McNemar tests with discrete Bonferroni-Holm correction. Feature relevance was analyzed using Layer-wise Relevance Propagation, image similarity metrics, and spectral clustering of relevance maps. Results: Despite substantial differences in image content, classification accuracy, sensitivity, and specificity remained stable across preprocessing conditions. Models trained on binarized images preserved performance, indicating minimal reliance on gray-white matter texture. Instead, volumetric features -- particularly brain contours introduced through skull-stripping -- were consistently used by the models. Conclusions: This behavior reflects a shortcut learning phenomenon, where preprocessing artifacts act as potentially unintended cues. The resulting Clever Hans effect emphasizes the critical importance of interpretability tools to reveal hidden biases and to ensure robust and trustworthy deep learning in medical imaging.