CheXplaining in Style: Counterfactual Explanations for Chest X-rays using StyleGAN
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Abstract (arXiv)
Deep learning models used in medical image analysis are prone to raising reliability concerns due to their black-box nature. To shed light on these black-box models, previous works predominantly focus on identifying the contribution of input features to the diagnosis, i.e., feature attribution. In this work, we explore counterfactual explanations to identify what patterns the models rely on for diagnosis. Specifically, we investigate the effect of changing features within chest X-rays on the classifier's output to understand its decision mechanism. We leverage a StyleGAN-based approach (StyleEx) to create counterfactual explanations for chest X-rays by manipulating specific latent directions in their latent space. In addition, we propose EigenFind to significantly reduce the computation time of generated explanations. We clinically evaluate the relevancy of our counterfactual explanations with the help of radiologists. Our code is publicly available.
Key facts. Cited by 25 papers in the map (data through 7 Oct 2026). Builds on 10 of its 10 references that are in the map. First posted on arXiv 15 Jul 2022.
Builds on
10 of 10 references.
References · 10
- 2019Analyzing and Improving the Image Quality of StyleGANcited by 3,580
- 2019CheXpert: A Large Chest Radiograph Dataset with Uncertainty Labels and Expert Comparisoncited by 1,410
- 2017ChestX-ray8: Hospital-scale Chest X-ray Database and Benchmarks on Weakly-Supervised Classification and Localization of Common Thorax Diseasescited by 969
- 2017CheXNet: Radiologist-Level Pneumonia Detection on Chest X-Rays with Deep Learningcited by 459
- 2020Closed-Form Factorization of Latent Semantics in GANscited by 407
- 2020StyleSpace Analysis: Disentangled Controls for StyleGAN Image Generationcited by 331
- 2021Explaining in Style: Training a GAN to explain a classifier in StyleSpacecited by 122
- 2018DeepMiner: Discovering Interpretable Representations for Mammogram Classification and Explanationcited by 9
- 2021Explaining COVID-19 and Thoracic Pathology Model Predictions by Identifying Informative Input Featurescited by 9
- 2021Towards Semantic Interpretation of Thoracic Disease and COVID-19 Diagnosis Modelscited by 9
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Citing papers per year: 2023: 6; 2024: 12; 2025: 6; 2026: 1.
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- 2023BiomedJourney: Counterfactual Biomedical Image Generation by Instruction-Learning from Multimodal Patient Journeyscited by 29
- 2023DreaMR: Diffusion-driven Counterfactual Explanation for Functional MRIcited by 14
- 2024Robust image representations with counterfactual contrastive learningcited by 12
- 2024Counterfactual contrastive learning: robust representations via causal image synthesiscited by 11
- 2024Counterfactual Explanations for Medical Image Classification and Regression using Diffusion Autoencodercited by 10
- 2024Generating Counterfactual Trajectories with Latent Diffusion Models for Concept Discoverycited by 8
- 2024MedEdit: Counterfactual Diffusion-based Image Editing on Brain MRIcited by 8
- 2024Accurate Explanation Model for Image Classifiers using Class Association Embeddingcited by 6
- 2025ProjectedEx: Enhancing Generation in Explainable AI for Prostate Cancercited by 6
- 2023Shortcut Detection with Variational Autoencoderscited by 5
- 2024DiffExplainer: Unveiling Black Box Models Via Counterfactual Generationcited by 5
- 2023Semantic Latent Space Regression of Diffusion Autoencoders for Vertebral Fracture Gradingcited by 2
13 more
- 2023Density-based Feasibility Learning with Normalizing Flows for Introspective Robotic Assemblycited by 2
- 2024COIN: Counterfactual inpainting for weakly supervised semantic segmentation for medical imagescited by 2
- 2024Decoding Decision Reasoning: A Counterfactual-Powered Model for Knowledge Discoverycited by 1
- 2024Cyclic Vision-Language Manipulator: Towards Reliable and Fine-Grained Image Interpretation for Automated Report Generationcited by 1
- 2023Autism Spectrum Disorder Classification with Interpretability in Children based on Structural MRI Features Extracted using Contrastive Variational Autoencodercited by 0
- 2024Explaining Chest X-ray Pathology Models using Textual Conceptscited by 0
- 2024TACE: Tumor-Aware Counterfactual Explanationscited by 0
- 2025Discovering Concept Directions from Diffusion-based Counterfactuals via Latent Clusteringcited by 0
- 2025Towards generating more interpretable counterfactuals via concept vectors: a preliminary study on chest X-rayscited by 0
- 2025Pixel Perfect MegaMed: A Megapixel-Scale Vision-Language Foundation Model for Generating High Resolution Medical Imagescited by 0
- 2025Counterfactual Explanations in Medical Imaging: Exploring SPN-Guided Latent Space Manipulationcited by 0
- 2025Hide-and-Seek Attribution: Weakly Supervised Segmentation of Vertebral Metastases in CTcited by 0
- 2026Reliability, Faithfulness, and the Limits of Post-hoc Explanations of Opaque Scientific Modelscited by 0
- 2026Reliability, Faithfulness, and the Limits of Post-hoc Explanations of Opaque Scientific Models28 Jun 2026
- 2025Hide-and-Seek Attribution: Weakly Supervised Segmentation of Vertebral Metastases in CT7 Dec 2025
- 2025Counterfactual Explanations in Medical Imaging: Exploring SPN-Guided Latent Space Manipulation25 Jul 2025
- 2025Pixel Perfect MegaMed: A Megapixel-Scale Vision-Language Foundation Model for Generating High Resolution Medical Images17 Jul 2025
- 2025Towards generating more interpretable counterfactuals via concept vectors: a preliminary study on chest X-rays4 Jun 2025
- 2025Discovering Concept Directions from Diffusion-based Counterfactuals via Latent Clustering11 May 2025
- 2025ProjectedEx: Enhancing Generation in Explainable AI for Prostate Cancer2 Jan 2025
- 2024Cyclic Vision-Language Manipulator: Towards Reliable and Fine-Grained Image Interpretation for Automated Report Generation8 Nov 2024
- 2024TACE: Tumor-Aware Counterfactual Explanations19 Sep 2024
- 2024Robust image representations with counterfactual contrastive learning16 Sep 2024
- 2024Counterfactual Explanations for Medical Image Classification and Regression using Diffusion Autoencoder2 Aug 2024
- 2024MedEdit: Counterfactual Diffusion-based Image Editing on Brain MRI21 Jul 2024
13 more
- 2024Explaining Chest X-ray Pathology Models using Textual Concepts30 Jun 2024
- 2024DiffExplainer: Unveiling Black Box Models Via Counterfactual Generation21 Jun 2024
- 2024Accurate Explanation Model for Image Classifiers using Class Association Embedding12 Jun 2024
- 2024Decoding Decision Reasoning: A Counterfactual-Powered Model for Knowledge Discovery23 May 2024
- 2024COIN: Counterfactual inpainting for weakly supervised semantic segmentation for medical images19 Apr 2024
- 2024Generating Counterfactual Trajectories with Latent Diffusion Models for Concept Discovery16 Apr 2024
- 2024Counterfactual contrastive learning: robust representations via causal image synthesis14 Mar 2024
- 2023BiomedJourney: Counterfactual Biomedical Image Generation by Instruction-Learning from Multimodal Patient Journeys16 Oct 2023
- 2023DreaMR: Diffusion-driven Counterfactual Explanation for Functional MRI18 Jul 2023
- 2023Density-based Feasibility Learning with Normalizing Flows for Introspective Robotic Assembly3 Jul 2023
- 2023Autism Spectrum Disorder Classification with Interpretability in Children based on Structural MRI Features Extracted using Contrastive Variational Autoencoder3 Jul 2023
- 2023Semantic Latent Space Regression of Diffusion Autoencoders for Vertebral Fracture Grading21 Mar 2023
- 2023Shortcut Detection with Variational Autoencoders8 Feb 2023
- 2023BiomedJourney: Counterfactual Biomedical Image Generation by Instruction-Learning from Multimodal Patient Journeyscited by 29
- 2023DreaMR: Diffusion-driven Counterfactual Explanation for Functional MRIcited by 14
- 2024Robust image representations with counterfactual contrastive learningcited by 12
- 2024Counterfactual contrastive learning: robust representations via causal image synthesiscited by 11
- 2024Counterfactual Explanations for Medical Image Classification and Regression using Diffusion Autoencodercited by 10
- 2024Accurate Explanation Model for Image Classifiers using Class Association Embeddingcited by 6
- 2025ProjectedEx: Enhancing Generation in Explainable AI for Prostate Cancercited by 6
- 2023Shortcut Detection with Variational Autoencoderscited by 5
- 2024DiffExplainer: Unveiling Black Box Models Via Counterfactual Generationcited by 5
- 2023Semantic Latent Space Regression of Diffusion Autoencoders for Vertebral Fracture Gradingcited by 2
- 2023Density-based Feasibility Learning with Normalizing Flows for Introspective Robotic Assemblycited by 2
- 2024COIN: Counterfactual inpainting for weakly supervised semantic segmentation for medical imagescited by 2
12 most cited of 22 All 22 (JSON)
- 2026Reliability, Faithfulness, and the Limits of Post-hoc Explanations of Opaque Scientific Models28 Jun 2026
- 2025Hide-and-Seek Attribution: Weakly Supervised Segmentation of Vertebral Metastases in CT7 Dec 2025
- 2025Counterfactual Explanations in Medical Imaging: Exploring SPN-Guided Latent Space Manipulation25 Jul 2025
- 2025Towards generating more interpretable counterfactuals via concept vectors: a preliminary study on chest X-rays4 Jun 2025
- 2025Discovering Concept Directions from Diffusion-based Counterfactuals via Latent Clustering11 May 2025
- 2025ProjectedEx: Enhancing Generation in Explainable AI for Prostate Cancer2 Jan 2025
- 2024Cyclic Vision-Language Manipulator: Towards Reliable and Fine-Grained Image Interpretation for Automated Report Generation8 Nov 2024
- 2024TACE: Tumor-Aware Counterfactual Explanations19 Sep 2024
- 2024Robust image representations with counterfactual contrastive learning16 Sep 2024
- 2024Counterfactual Explanations for Medical Image Classification and Regression using Diffusion Autoencoder2 Aug 2024
- 2024Explaining Chest X-ray Pathology Models using Textual Concepts30 Jun 2024
- 2024DiffExplainer: Unveiling Black Box Models Via Counterfactual Generation21 Jun 2024
12 newest of 22 All 22 (JSON)