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Verity plots: A novel method of visualizing reliability assessments of artificial intelligence methods in quantitative cardiovascular magnetic resonance

T. Hadler,Clemens Ammann,Hadil Saad,Leonhard Grassow,Philine Reisdorf,Steffen Lange,Sascha Däuber,Jeanette Schulz-Menger

Published 2025 in PLoS ONE

ABSTRACT

Background Artificial intelligence (AI) methods have established themselves in cardiovascular magnetic resonance (CMR) as automated quantification tools for ventricular volumes, function, and myocardial tissue characterization. Quality assurance approaches focus on measuring and controlling AI-expert differences but there is a need for tools that better communicate reliability and agreement. This study introduces the Verity plot, a novel statistical visualization that communicates the reliability of quantitative parameters (QP) with clear agreement criteria and descriptive statistics. Methods Tolerance ranges for the acceptability of the bias and variance of AI-expert differences were derived from intra- and interreader evaluations. AI-expert agreement was defined by bias confidence and variance tolerance intervals being within bias and variance tolerance ranges. A reliability plot was designed to communicate this statistical test for agreement. Verity plots merge reliability plots with density and a scatter plot to illustrate AI-expert differences. Their utility was compared against Correlation, Box and Bland-Altman plots. Results Bias and variance tolerance ranges were established for volume, function, and myocardial tissue characterization QPs. Verity plots provided insights into statstistcal properties, outlier detection, and parametric test assumptions, outperforming Correlation, Box and Bland-Altman plots. Additionally, they offered a framework for determining the acceptability of AI-expert bias and variance. Conclusion Verity plots offer markers for bias, variance, trends and outliers, in addition to deciding AI quantification acceptability. The plots were successfully applied to various AI methods in CMR and decisively communicated AI-expert agreement.

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