Prediction of intracerebral hemorrhage hematoma expansion: value of a novel deep learning system score

To develop and validate a deep learning system (DLS) model predicting hematoma expansion (HE) based on non-contrast (NC) CT and a score combining with clinical variables.

The multicenter retrospective dataset (R), the multicenter prospective dataset (P1), and the single-center prospective dataset (P2) enrolled 2350, 460, and 96 intracerebral hemorrhage (ICH) patients for analysis, respectively. The DLS model was developed, validated, and tested in R-development (R-dev), R-validation (R-val), and P1, respectively. After exploring clinical predictors of HE using multivariable logistic regression on P1-development (P1-dev), a five-point score "ARCHES" (Ai-Reinforced intraCerebral Hemorrhage hematoma Expansion Score) combining clinical predictors with the DLS model was created. We compared the discrimination of the ARCHES, DLS, with other models using the receiver operating characteristic (ROC) and DeLong test.

The areas under the curve (AUC) of the DLS model were 0.781 (95% CI: 0.761-0.800) in R-dev, and showed similar results in P1. The ARCHES score, which includes DLS, baseline National Institutes of Health Stroke Scale (NIHSS), onset-to-NCCT time and regular antihypertension history, showed significantly better discrimination (AUC, 0.820; 95% CI: 0.775-0.859) than the blend sign and any hypodensity and time from onset-to-NCCT (BAT) score and the meta-analysis prediction model in P1-dev, P1-validation (P1-val) and P2.

The DLS model provides an automated, objective, rapid, and readily deployable tool for HE prediction only based on NCCT. The DLS model and the ARCHES score significantly improve risk stratification with better performance than previous HE prediction models, enabling timely clinical decisions for intensive monitoring and anti-HE therapy.

Question Lacking reliable NCCT-based deep learning models (DLS) and a score combining with clinical variables for HE prediction. Findings A NCCT-based DLS model and a score combining with clinical variables were developed and tested, both showing good discrimination and calibration in predicting HE. Clinical relevant The DLS model enables automated and rapid HE prediction, while the easy-to-use score combines imaging and clinical variables, making it ideal for use in emergency settings. Both models improve risk stratification and support clinical decision-making in acute intracranial hemorrhage.