Abstract
OBJECTIVE: This study introduces MSFE-GallNet-X, a domain-adaptive deep learning model utilizing multi-scale feature extraction (MSFE) to improve the classification accuracy of gallbladder diseases from grayscale ultrasound images, while integrating explainable artificial intelligence (XAI) methods to enhance clinical interpretability. METHODS: We developed a convolutional neural network-based architecture that automatically learns multi-scale features from a dataset comprising 10,692 high-resolution ultrasound images from 1,782 patients, covering nine gallbladder disease classes, including gallstones, cholecystitis, and carcinoma. The model incorporated Gradient-Weighted Class Activation Mapping (Grad-CAM) and Local Interpretable Model-Agnostic Explanations (LIME) to provide visual interpretability of diagnostic predictions. Model performance was evaluated using standard metrics, including accuracy and F1 score. RESULTS: The MSFE-GallNet-X achieved a classification accuracy of 99.63% and an F1 score of 99.50%, outperforming state-of-the-art models including VGG-19 (98.89%) and DenseNet121 (91.81%), while maintaining greater parameter efficiency, only 1·91 M parameters in gallbladder disease classification. Visualization through Grad-CAM and LIME highlighted critical image regions influencing model predictions, supporting explainability for clinical use. CONCLUSION: MSFE-GallNet-X demonstrates strong performance on a controlled and balanced dataset, suggesting its potential as an AI-assisted tool for clinical decision-making in gallbladder disease management. CLINICAL TRIAL NUMBER: Not applicable.