AI-based association analysis for medical imaging using latent-space geometric confounder correction

This study addresses the challenges of confounding effects and interpretability in artificial-intelligence-based medical image analysis. Whereas existing literature often resolves confounding by removing confounder-related information from latent representations, this strategy risks affecting image reconstruction quality in generative models, thus limiting their applicability in feature visualization. To tackle this, we propose a different strategy that retains confounder-related information in latent representations while finding an alternative confounder-free representation of the image data. Our approach views the latent space of an autoencoder as a vector space, where imaging-related variables, such as the learning target (t) and confounder (c), have a vector capturing their variability. The confounding problem is addressed by searching a confounder-free vector which is orthogonal to the confounder-related vector but maximally collinear to the target-related vector. To achieve this, we introduce a novel correlation-based loss that not only performs vector searching in the latent space, but also encourages the encoder to generate latent representations linearly correlated with the variables. Subsequently, we interpret the confounder-free representation by sampling and reconstructing images along the confounder-free vector. The efficacy and flexibility of our proposed method are demonstrated across three applications, accommodating multiple confounders and utilizing diverse image modalities. Results affirm the method's effectiveness in reducing confounder influences, preventing wrong or misleading associations, and offering a unique visual interpretation for in-depth investigations by clinical and epidemiological researchers. The code is released in the following GitLab repository: https://gitlab.com/radiology/compopbio/ai_based_association_analysis.