Diffusion-based Counterfactual Augmentation: Towards Robust and Interpretable Knee Osteoarthritis Grading

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Main Authors: Wang, Zhe, Ru, Yuhua, Chetouani, Aladine, Shiang, Tina, Chen, Fang, Bauer, Fabian, Zhang, Liping, Hans, Didier, Jennane, Rachid, Palmer, William Ewing, Jarraya, Mohamed, Chen, Yung Hsin
Format: Preprint
Published: 2025
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author Wang, Zhe
Ru, Yuhua
Chetouani, Aladine
Shiang, Tina
Chen, Fang
Bauer, Fabian
Zhang, Liping
Hans, Didier
Jennane, Rachid
Palmer, William Ewing
Jarraya, Mohamed
Chen, Yung Hsin
author_facet Wang, Zhe
Ru, Yuhua
Chetouani, Aladine
Shiang, Tina
Chen, Fang
Bauer, Fabian
Zhang, Liping
Hans, Didier
Jennane, Rachid
Palmer, William Ewing
Jarraya, Mohamed
Chen, Yung Hsin
contents Automated grading of Knee Osteoarthritis (KOA) from radiographs is challenged by significant inter-observer variability and the limited robustness of deep learning models, particularly near critical decision boundaries. To address these limitations, this paper proposes a novel framework, Diffusion-based Counterfactual Augmentation (DCA), which enhances model robustness and interpretability by generating targeted counterfactual examples. The method navigates the latent space of a diffusion model using a Stochastic Differential Equation (SDE), governed by balancing a classifier-informed boundary drive with a manifold constraint. The resulting counterfactuals are then used within a self-corrective learning strategy to improve the classifier by focusing on its specific areas of uncertainty. Extensive experiments on the public Osteoarthritis Initiative (OAI) and Multicenter Osteoarthritis Study (MOST) datasets demonstrate that this approach significantly improves classification accuracy across multiple model architectures. Furthermore, the method provides interpretability by visualizing minimal pathological changes and revealing that the learned latent space topology aligns with clinical knowledge of KOA progression. The DCA framework effectively converts model uncertainty into a robust training signal, offering a promising pathway to developing more accurate and trustworthy automated diagnostic systems. Our code is available at https://github.com/ZWang78/DCA.
format Preprint
id arxiv_https___arxiv_org_abs_2506_15748
institution arXiv
publishDate 2025
record_format arxiv
spellingShingle Diffusion-based Counterfactual Augmentation: Towards Robust and Interpretable Knee Osteoarthritis Grading
Wang, Zhe
Ru, Yuhua
Chetouani, Aladine
Shiang, Tina
Chen, Fang
Bauer, Fabian
Zhang, Liping
Hans, Didier
Jennane, Rachid
Palmer, William Ewing
Jarraya, Mohamed
Chen, Yung Hsin
Image and Video Processing
Computer Vision and Pattern Recognition
Automated grading of Knee Osteoarthritis (KOA) from radiographs is challenged by significant inter-observer variability and the limited robustness of deep learning models, particularly near critical decision boundaries. To address these limitations, this paper proposes a novel framework, Diffusion-based Counterfactual Augmentation (DCA), which enhances model robustness and interpretability by generating targeted counterfactual examples. The method navigates the latent space of a diffusion model using a Stochastic Differential Equation (SDE), governed by balancing a classifier-informed boundary drive with a manifold constraint. The resulting counterfactuals are then used within a self-corrective learning strategy to improve the classifier by focusing on its specific areas of uncertainty. Extensive experiments on the public Osteoarthritis Initiative (OAI) and Multicenter Osteoarthritis Study (MOST) datasets demonstrate that this approach significantly improves classification accuracy across multiple model architectures. Furthermore, the method provides interpretability by visualizing minimal pathological changes and revealing that the learned latent space topology aligns with clinical knowledge of KOA progression. The DCA framework effectively converts model uncertainty into a robust training signal, offering a promising pathway to developing more accurate and trustworthy automated diagnostic systems. Our code is available at https://github.com/ZWang78/DCA.
title Diffusion-based Counterfactual Augmentation: Towards Robust and Interpretable Knee Osteoarthritis Grading
topic Image and Video Processing
Computer Vision and Pattern Recognition
url https://arxiv.org/abs/2506.15748