Automated detection of 3D midline shift in spontaneous supratentorial intracerebral haemorrhage with non-contrast computed tomography using deep convolutional neural networks

Deep learning (DL)-based convolutional neural networks facilitate more accurate detection and rapid analysis of MLS. Our objective was to assess the feasibility of applying a DL-based convolutional neural network to non-contrast computed tomography (CT) for automated 2D/3D brain midline shift measurement and outcome prediction after spontaneous intracerebral haemorrhage. In this retrospective study, 140 consecutive patients were referred for CT assessment of sICH from January 2014 to April 2019. The level of consciousness of patients was evaluated using the Glasgow Coma Scale (GCS) score, and the Glasgow Outcome Scale (GOS) score was calculated to classify the outcome. The distance of midline shift (MLS-D) and volume of midline shift (MLS-V) were automatically measured via DL methods. Patients were divided into three groups based on GCS scores: mild degree (GCS score: 13-15), moderate degree (GCS score: 9-12), and severe degree (GCS score: 3-8). Spearman's correlation analysis revealed statistically significant (P<0.01) positive correlation between GCS and MLS-D (r=0.709) and MLS-V (r=0.754). The AUC of MLS-V was slightly larger than that of MLS-D (0.831 vs 0.799, P=0.318) in the midline shifting group. The AUC of MLS-V was significantly larger than that of MLS-D (0.854 vs 0.736, P=0.03) in patients with severe degree GCS scores. The DL-based measurements of both MLS-D and MLS-V enable the assessment of consciousness and the prediction of the outcome of sICH. Compared to MLS-D, MLS-V measurement can better indicate mass effect and predict outcomes, particularly in severe cases.