Tran Anh T, Zeevi Tal, Haider Stefan P, Abou Karam Gaby, Berson Elisa R, Tharmaseelan Hishan, Qureshi Adnan I, Sanelli Pina C, Werring David J, Malhotra Ajay, Petersen Nils H, de Havenon Adam, Falcone Guido J, Sheth Kevin N, Payabvash Seyedmehdi
Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
Department of Otorhinolaryngology, University Hospital of Ludwig Maximilians Universität München, Munich, Germany.
NPJ Digit Med. 2024 Feb 6;7(1):26. doi: 10.1038/s41746-024-01007-w.
Hematoma expansion (HE) is a modifiable risk factor and a potential treatment target in patients with intracerebral hemorrhage (ICH). We aimed to train and validate deep-learning models for high-confidence prediction of supratentorial ICH expansion, based on admission non-contrast head Computed Tomography (CT). Applying Monte Carlo dropout and entropy of deep-learning model predictions, we estimated the model uncertainty and identified patients at high risk of HE with high confidence. Using the receiver operating characteristics area under the curve (AUC), we compared the deep-learning model prediction performance with multivariable models based on visual markers of HE determined by expert reviewers. We randomly split a multicentric dataset of patients (4-to-1) into training/cross-validation (n = 634) versus test (n = 159) cohorts. We trained and tested separate models for prediction of ≥6 mL and ≥3 mL ICH expansion. The deep-learning models achieved an AUC = 0.81 for high-confidence prediction of HE and AUC = 0.80 for prediction of HE, which were higher than visual maker models AUC = 0.69 for HE (p = 0.036) and AUC = 0.68 for HE (p = 0.043). Our results show that fully automated deep-learning models can identify patients at risk of supratentorial ICH expansion based on admission non-contrast head CT, with high confidence, and more accurately than benchmark visual markers.
血肿扩大(HE)是脑出血(ICH)患者中一个可改变的风险因素及潜在治疗靶点。我们旨在基于入院时的非增强头颅计算机断层扫描(CT),训练并验证用于高置信度预测幕上ICH扩大的深度学习模型。应用蒙特卡洛随机失活和深度学习模型预测的熵,我们估计了模型不确定性,并高置信度地识别出有HE高风险的患者。使用曲线下面积(AUC)的受试者工作特征,我们将深度学习模型的预测性能与基于专家评审确定的HE视觉标志物的多变量模型进行了比较。我们将患者的多中心数据集随机按4比1的比例分为训练/交叉验证队列(n = 634)和测试队列(n = 159)。我们分别训练并测试了用于预测ICH扩大≥6 mL和≥3 mL的模型。深度学习模型在高置信度预测HE方面的AUC = 0.81,预测HE方面的AUC = 0.80,高于视觉标志物模型预测HE的AUC = 0.69(p = 0.036)和预测HE的AUC = 0.68(p = 0.043)。我们的结果表明,全自动深度学习模型能够基于入院时的非增强头颅CT高置信度地识别幕上ICH扩大风险患者,且比基准视觉标志物更准确。