DINMC: A Deep Learning Framework for Interpretable Normative Model Construction and Pathological Brain Alteration Detection

Background and Objective: Normative modeling is a key tool for understanding brain alterations in neurodegenerative diseases, such as cerebellar-type multiple system atrophy. However, existing methods lack interpretability and fail to capture clinically meaningful pathological changes. This study presents DINMC, a Deep Interpretable Normative Model Construction framework, which combines autoencoder-based learning with statistical hypothesis testing to better capture and interpret disease-specific neuroanatomical changes. Methods: The DINMC framework constructs normative models using neuroimaging data from multi-site large healthy cohorts. It utilizes a U-shaped convolutional autoencoder to train these models, which are then applied to reconstruct brain features from both patients and healthy controls within the same study cohort. Pathological confidence values are derived by fusing original and deviation feature spaces, offering a measure of disease-related pathology reflected in each dimension of the features. The framework was validated through statistical analysis and prognostic classification and regression tasks. Results: The pathological confidence provides valuable insights into the neuroanatomical regions most affected by the disease, as well as the correlation between changes in these regions and clinical assessment scales. Our optimal model outperform traditional methods in prognostic prediction tasks, with an AUC of 0.972 for classification tasks and an R-squared of 0.432 for regression tasks. Conclusion: DINMC provides a novel and interpretable framework for neuroimaging analysis. By combining deep learning and statistical hypothesis testing, this framework offers a unique solution to improving both the interpretability and performance of normative models in neuroimaging. The approach is scalable to other neuroimaging datasets, offering a versatile tool for broader biomedical applications.