# Methodological Explainability Evaluation of an Interpretable Deep Learning Model for Post-Hepatectomy Liver Failure Prediction Incorporating Counterfactual Explanations and Layerwise Relevance Propagation: A Prospective In Silico Trial

arXiv: https://arxiv.org/abs/2408.03771 · HTML: https://mlsanity.com/paper/2408.03771/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 17 of its 63 references that are in the map.
- First posted on arXiv 7 Aug 2024.

## Builds on (most cited first, 17 of 17)

- [Concept Bottleneck Models](https://mlsanity.com/paper/2007.04612/) (2020)
- [A Survey on Explainable Artificial Intelligence (XAI): Towards Medical XAI](https://mlsanity.com/paper/1907.07374/) (2019)
- [European Union regulations on algorithmic decision-making and a "right to explanation"](https://mlsanity.com/paper/1606.08813/) (2016)
- [Counterfactual Explanations and Algorithmic Recourses for Machine Learning: A Review](https://mlsanity.com/paper/2010.10596/) (2020)
- [Explainable deep learning models in medical image analysis](https://mlsanity.com/paper/2005.13799/) (2020)
- [Anatomically Constrained Neural Networks (ACNN): Application to Cardiac Image Enhancement and Segmentation](https://mlsanity.com/paper/1705.08302/) (2017)
- [What I Cannot Predict, I Do Not Understand: A Human-Centered Evaluation Framework for Explainability Methods](https://mlsanity.com/paper/2112.04417/) (2021)
- [Transparency of Deep Neural Networks for Medical Image Analysis: A Review of Interpretability Methods](https://mlsanity.com/paper/2111.02398/) (2021)
- [Explanation by Progressive Exaggeration](https://mlsanity.com/paper/1911.00483/) (2019)
- [Measuring the Quality of Explanations: The System Causability Scale (SCS). Comparing Human and Machine Explanations](https://mlsanity.com/paper/1912.09024/) (2019)
- [DISSECT: Disentangled Simultaneous Explanations via Concept Traversals](https://mlsanity.com/paper/2105.15164/) (2021)
- [Using StyleGAN for Visual Interpretability of Deep Learning Models on Medical Images](https://mlsanity.com/paper/2101.07563/) (2021)
- [Explainable Medical Imaging AI Needs Human-Centered Design: Guidelines and Evidence from a Systematic Review](https://mlsanity.com/paper/2112.12596/) (2021)
- [Interpretable Deep Neural Networks for Single-Trial EEG Classification](https://mlsanity.com/paper/1604.08201/) (2016)
- [The impact of patient clinical information on automated skin cancer detection](https://mlsanity.com/paper/1909.12912/) (2019)
- [Dermatologist-like explainable AI enhances trust and confidence in diagnosing melanoma](https://mlsanity.com/paper/2303.12806/) (2023)
- [Interpretable Deep Models for Cardiac Resynchronisation Therapy Response Prediction](https://mlsanity.com/paper/2006.13811/) (2020)

## Abstract (arXiv)

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.