Interpretability and Individuality in Knee MRI: Patient-Specific Radiomic Fingerprint with Reconstructed Healthy Personas

Abstract: For automated assessment of knee MRI scans, both accuracy and interpretability are essential for clinical use and adoption. Traditional radiomics rely on predefined features chosen at the population level; while more interpretable, they are often too restrictive to capture patient-specific variability and can underperform end-to-end deep learning (DL). To address this, we propose two complementary strategies that bring individuality and interpretability: radiomic fingerprints and healthy personas. First, a radiomic fingerprint is a dynamically constructed, patient-specific feature set derived from MRI. Instead of applying a uniform population-level signature, our model predicts feature relevance from a pool of candidate features and selects only those most predictive for each patient, while maintaining feature-level interpretability. This fingerprint can be viewed as a latent-variable model of feature usage, where an image-conditioned predictor estimates usage probabilities and a transparent logistic regression with global coefficients performs classification. Second, a healthy persona synthesises a pathology-free baseline for each patient using a diffusion model trained to reconstruct healthy knee MRIs. Comparing features extracted from pathological images against their personas highlights deviations from normal anatomy, enabling intuitive, case-specific explanations of disease manifestations. We systematically compare fingerprints, personas, and their combination across three clinical tasks. Experimental results show that both approaches yield performance comparable to or surpassing state-of-the-art DL models, while supporting interpretability at multiple levels. Case studies further illustrate how these perspectives facilitate human-explainable biomarker discovery and pathology localisation.