Interpretable classification of Alzheimer’s disease pathologies with a convolutional neural network pipeline

Neuropathologists assess vast brain areas to identify diverse and subtly-differentiated morphologies. Standard semi-quantitative scoring approaches, however, are coarse-grained and can lack precise neuroanatomic localization. We report a proof-of-concept deep learning pipeline identifying specific neuropathologies--amyloid plaques and cerebral amyloid angiopathy--in immunohistochemical-stained archival slides. Using automated segmentation of stained objects and a cloud-based interface, we annotated >70,000 plaque candidates from 43 whole slide images (WSIs) to train and evaluate convolutional neural networks. Networks achieved strong plaque classification (0.993 and 0.744 areas under the receiver operating characteristic and precision recall curve, respectively) on a 10 WSI hold-out set. Prediction confidence maps visualized morphology distributions from the full-WSI level down to 20x magnification. Resulting plaque-burden scores correlated well with established semi-quantitative scores. Finally, saliency mapping demonstrated that networks learned patterns agreeing with accepted pathologic features. This scalable means to augment a neuropathologists ability may suggest a route to neuropathologic deep phenotyping.