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Background The imaging features of focal liver lesions (FLLs) are diverse and complex. Diagnosing FLLs with imaging alone remains challenging. We developed and validated an interpretable deep learning model for the classification of seven categories of FLLs on multisequence MRI and compared the differential diagnosis between the proposed model and radiologists. Methods In all, 557 lesions examined by multisequence MRI were utilised in this retrospective study and divided into training–validation ( n  = 444) and test ( n  = 113) datasets. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the performance of the model. The accuracy and confusion matrix of the model and individual radiologists were compared. Saliency maps were generated to highlight the activation region based on the model perspective. Results The AUC of the two- and seven-way classifications of the model were 0.969 (95% CI 0.944–0.994) and from 0.919 (95% CI 0.857–0.980) to 0.999 (95% CI 0.996–1.000), respectively. The model accuracy (79.6%) of the seven-way classification was higher than that of the radiology residents (66.4%,  p  = 0.035) and general radiologists (73.5%,  p  = 0.346) but lower than that of the academic radiologists (85.4%,  p  = 0.291). Confusion matrices showed the sources of diagnostic errors for the model and individual radiologists for each disease. Saliency maps detected the activation regions associated with each predicted class. Conclusion This interpretable deep learning model showed high diagnostic performance in the differentiation of FLLs on multisequence MRI. The analysis principle contributing to the predictions can be explained via saliency maps.

Saliency-based 3D convolutional neural network for categorising common focal liver lesions on multisequence MRI