An explainable AI system for automated COVID-19 assessment and lesion categorization from CT-scans

Matteo Pennisi, Isaak Kavasidis, Concetto Spampinato, Vincenzo Schinina, Simone Palazzo, Federica Proietto Salanitri, Giovanni Bellitto, Francesco Rundo, Marco Aldinucci, Massimo Cristofaro, Paolo Campioni, Elisa Pianura, Federica Di Stefano, Ada Petrone, Fabrizio Albarello, Giuseppe Ippolito, Salvatore Cuzzocrea, Sabrina Conoci

Research output: Contribution to journalArticlepeer-review


COVID-19 infection caused by SARS-CoV-2 pathogen has been a catastrophic pandemic outbreak all over the world, with exponential increasing of confirmed cases and, unfortunately, deaths. In this work we propose an AI-powered pipeline, based on the deep-learning paradigm, for automated COVID-19 detection and lesion categorization from CT scans. We first propose a new segmentation module aimed at automatically identifying lung parenchyma and lobes. Next, we combine the segmentation network with classification networks for COVID-19 identification and lesion categorization. We compare the model's classification results with those obtained by three expert radiologists on a dataset of 166 CT scans. Results showed a sensitivity of 90.3% and a specificity of 93.5% for COVID-19 detection, at least on par with those yielded by the expert radiologists, and an average lesion categorization accuracy of about 84%. Moreover, a significant role is played by prior lung and lobe segmentation, that allowed us to enhance classification performance by over 6 percent points. The interpretation of the trained AI models reveals that the most significant areas for supporting the decision on COVID-19 identification are consistent with the lesions clinically associated to the virus, i.e., crazy paving, consolidation and ground glass. This means that the artificial models are able to discriminate a positive patient from a negative one (both controls and patients with interstitial pneumonia tested negative to COVID) by evaluating the presence of those lesions into CT scans. Finally, the AI models are integrated into a user-friendly GUI to support AI explainability for radiologists, which is publicly available at The whole AI system is unique since, to the best of our knowledge, it is the first AI-based software, publicly available, that attempts to explain to radiologists what information is used by AI methods for making decisions and that proactively involves them in the decision loop to further improve the COVID-19 understanding.

Original languageEnglish
Article number102114
Pages (from-to)1-12
Number of pages12
JournalArtificial Intelligence in Medicine
Publication statusPublished - Aug 2021


  • COVID-19 detection
  • Deep learning
  • Lung segmentation

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Artificial Intelligence


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