用深度学习结合临床与影像数据,快速准确定位颅内血肿。
Detection and Localization of Subdural Hematoma Using Deep Learning on Computed Tomography
- 融合临床数据和3D/2D影像模型,实现多模态分析。
- 在近4千例病例中达到0.94的检测准确率,优于单一模型。
- 输出可解释的定位图,适合临床医生实时决策使用。
硬膜下血肿(SDH)是常见神经外科急症,随人口老龄化发病率上升。快速准确识别对及时干预至关重要,但现有自动化工具多聚焦检测,缺乏可解释性与空间定位能力。本研究构建了多模态深度学习框架,整合结构化临床变量、基于CT体积的3D卷积神经网络及增强型2D分割模型,用于SDH检测与定位。基于哈特福德健康护理机构2015至2024年共25,315例头颅CT数据(其中3,774例经临床确认为SDH),训练表格式模型分析人口统计、合并症、用药及实验室结果;影像模型则用于检测并生成体素级概率图。采用贪心集成策略融合互补预测器。结果显示,仅临床变量判别力较弱(AUC 0.75),而3D卷积模型与分割图模型分别达到0.922和0.926的高准确率。多模态集成系统表现最优(AUC 0.9407;95%置信区间0.930–0.951),并生成符合已知血肿分布模式的解剖学有意义定位图。该框架提供快速、精准且可解释的检测与定位,有望融入放射科工作流,优化分诊效率,缩短干预时间,提升管理一致性。
原文摘要 · Abstract (English)
Background. Subdural hematoma (SDH) is a common neurosurgical emergency, with increasing incidence in aging populations. Rapid and accurate identification is essential to guide timely intervention, yet existing automated tools focus primarily on detection and provide limited interpretability or spatial localization. There remains a need for transparent, high-performing systems that integrate multimodal clinical and imaging information to support real-time decision-making. Methods. We developed a multimodal deep-learning framework that integrates structured clinical variables, a 3D convolutional neural network trained on CT volumes, and a transformer-enhanced 2D segmentation model for SDH detection and localization. Using 25,315 head CT studies from Hartford HealthCare (2015--2024), of which 3,774 (14.9\%) contained clinician-confirmed SDH, tabular models were trained on demographics, comorbidities, medications, and laboratory results. Imaging models were trained to detect SDH and generate voxel-level probability maps. A greedy ensemble strategy combined complementary predictors. Findings. Clinical variables alone provided modest discriminatory power (AUC 0.75). Convolutional models trained on CT volumes and segmentation-derived maps achieved substantially higher accuracy (AUCs 0.922 and 0.926). The multimodal ensemble integrating all components achieved the best overall performance (AUC 0.9407; 95\% CI, 0.930--0.951) and produced anatomically meaningful localization maps consistent with known SDH patterns. Interpretation. This multimodal, interpretable framework provides rapid and accurate SDH detection and localization, achieving high detection performance and offering transparent, anatomically grounded outputs. Integration into radiology workflows could streamline triage, reduce time to intervention, and improve consistency in SDH management.
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