A Deep Learning-Based Framework for Predicting Intracerebral Hematoma Expansion Using Head Non-contrast CT Scan

Rationale and Objectives: Hematoma expansion (HE) in intracerebral hemorrhage (ICH) is a critical factor affecting patient outcomes, yet effective clinical tools for predicting HE are currently lacking. We aim to develop a fully automated framework based on deep learning for predicting HE using only clinical non-contrast CT (NCCT) scans. Materials and Methods: A large retrospective dataset (n = 2484) was collected from 84 centers, while a prospective dataset (n = 500) was obtained from 26 additional centers. Baseline NCCT scans and follow-up NCCT scans were conducted within 6 h and 48 h from symptom onset, respectively. HE was defined as a volume increase of more than 6 mL on the follow-up NCCT. The retrospective dataset was divided into a training set (n = 1876) and a validation set (n = 608) by patient inclusion time. A two-stage framework was trained to predict HE, and its performance was evaluated on both the validation and prospective sets. Receiver operating characteristics area under the curve (AUC), sensitivity, and specificity were leveraged. Results: Our two-stage framework achieved an AUC of 0.760 (95% CI 0.724–0.799) on the retrospective validation set and 0.806 (95% CI 0.750–0.859) on the prospective set, outperforming the commonly used BAT score, which had AUCs of 0.582 and 0.699, respectively. Conclusion: Our framework can automatically and robustly identify ICH patients at high risk of HE using admission head NCCT scans, providing more accurate predictions than the BAT score.