A Trusted Lesion-assessment Network for Interpretable Diagnosis of Coronary Artery Disease in Coronary CT Angiography

Abstract Coronary Artery Disease (CAD) poses a significant threat to cardiovascular patients worldwide, underscoring the critical importance of automated CAD diagnostic technologies in clinical practice. Previous technologies for lesion assessment in Coronary CT Angiography (CCTA) images have been insufficient in terms of interpretability, resulting in solutions that lack clinical reliability in both network architecture and prediction outcomes, even when diagnoses are accurate. To address the limitation of interpretability, we introduce the Trusted Lesion-Assessment Network (TLA-Net), which provides a clinically reliable solution for multi-view CAD diagnosis: (1) The causality-informed evidence collection constructs a causal graph for the diagnostic process and implements causal interventions, preventing confounders' interference and enhancing the transparency of the network architecture. (2) The clinically-aligned uncertainty integration hierarchically combines Dirichlet distributions from various views based on clinical priors, offering confidence coefficients for prediction outcomes that align with physicians' image analysis procedures. Experimental results on a dataset of 2,618 lesions demonstrate that TLA-Net, supported by its interpretable methodological design, exhibits superior performance with outstanding generalization, domain adaptability, and robustness.