Xian Zhong

Xian Zhong, Zohaib Salahuddin, Yi Chen et al.

Artificial intelligence (AI)-based decision support systems have demonstrated value in predicting post-hepatectomy liver failure (PHLF) in hepatocellular carcinoma (HCC). However, they often lack transparency, and the impact of model explanations on clinicians' decisions has not been thoroughly evaluated. Building on prior research, we developed a variational autoencoder-multilayer perceptron (VAE-MLP) model for preoperative PHLF prediction. This model integrated counterfactuals and layerwise relevance propagation (LRP) to provide insights into its decision-making mechanism. Additionally, we proposed a methodological framework for evaluating the explainability of AI systems. This framework includes qualitative and quantitative assessments of explanations against recognized biomarkers, usability evaluations, and an in silico clinical trial. Our evaluations demonstrated that the model's explanation correlated with established biomarkers and exhibited high usability at both the case and system levels. Furthermore, results from the three-track in silico clinical trial showed that clinicians' prediction accuracy and confidence increased when AI explanations were provided.

Shruti Atul Mali, Zohaib Salahuddin, Yumeng Zhang et al.

Colorectal liver metastases (CRLM) are a major cause of cancer-related mortality, and reliable detection on CT remains challenging in multi-centre settings. We developed a foundation model-based AI pipeline for patient-level classification and lesion-level detection of CRLM on contrast-enhanced CT, integrating uncertainty quantification and explainability. CT data from the EuCanImage consortium (n=2437) and an external TCIA cohort (n=197) were used. Among several pretrained models, UMedPT achieved the best performance and was fine-tuned with an MLP head for classification and an FCOS-based head for lesion detection. The classification model achieved an AUC of 0.90 and a sensitivity of 0.82 on the combined test set, with a sensitivity of 0.85 on the external cohort. Excluding the most uncertain 20 percent of cases improved AUC to 0.91 and balanced accuracy to 0.86. Decision curve analysis showed clinical benefit for threshold probabilities between 0.30 and 0.40. The detection model identified 69.1 percent of lesions overall, increasing from 30 percent to 98 percent across lesion size quartiles. Grad-CAM highlighted lesion-corresponding regions in high-confidence cases. These results demonstrate that foundation model-based pipelines can support robust and interpretable CRLM detection and classification across heterogeneous CT data.