Deep learning-based imaging model to predict early hematoma enlargement and hospital mortality in spontaneous intracerebral hemorrhage

Table 1 Clinical characteristics of patients in the training and testing cohorts, n (%)

Characteristic	Training cohort (n = 225)			Testing cohort (n = 97)
	Expander (n = 83, 36.9%)	Non-expander (n = 142, 63.1%)	P value	Expander (n = 35, 36.1%)	Non-expander (n = 62, 63.9%)	P value
Demographic characteristics
Age, median (IQR), years	61 (28)	61 (24)	0.651	62 (31)	59 (29)	0.276
Gender, male	49 (59.0)	81 (57.0)	0.77	28 (80.0)	33 (53.2)	0.1
Clinical features
Time to arrival, median (IQR), hour	1.6 (0.7)	1.5 (0.3)	0.092	1.4 (0.6)	1.6 (0.3)	0.363
Time to baseline CT, median (IQR), hour	2.4 (1.1)	2.2 (0.7)	0.101	1.8 (0.7)	1.9 (1.3)	0.925
Systolic BP, median (IQR), mmHg	146 (40)	147 (48)	0.296	142 (39)	144 (48)	0.976
Diastolic BP, median (IQR), mmHg	86 (25)	86 (27)	0.974	82 (27)	85 (22)	0.905
Heart rate, median (IQR), bpm	80 (18)	80 (18)	0.988	84 (24)	80 (20)	0.86
GCS score, median (IQR)	13 (4)	13 (5)	0.634	13 (3)	14 (3)	0.847
NIHSS score, median (IQR)	6 (14)	6 (12)	0.866	5 (11)	7 (11)	0.754
Medical history
Hypertension	43 (51.8)	67 (47.2)	0.503	18 (51.4)	26 (41.9)	0.367
Diabetes mellitus, male	8 (9.6)	14 (9.9)	0.957	3 (8.6)	6 (9.7)	1
Dyslipidemia	3 (3.6)	3 (2.1)	0.672	1 (2.9)	1 (1.6)	1
Atrial fibrillation	3 (3.6)	2 (1.4)	0.361	1 (2.9)	0 (0.0)	0.361
Acute coronary syndrome	3 (3.6)	4 (2.8)	0.711	0 (0.0)	4 (6.5)	0.293
Ischemic stroke	0 (0.0)	2 (1.4)	0.532	1 (2.9)	1 (1.6)	1
Current smoking	6 (7.2)	7 (4.9)	0.557	2 (5.7)	2 (3.2)	0.618
Drinking history	2 (2.4)	4 (2.8)	1	0 (0.0)	0 (0.0)	1
Medication history
Anti-platelet therapy	6 (7.2)	5 (3.5)	0.22	1 (2.9)	2 (3.2)	1
Anti-coagulant therapy	7 (8.4)	4 (2.8)	0.104	3 (8.6)	1 (1.6)	0.132

CT: Computed tomography; IQR: Interquartile range; BP: Blood pressure; GCS: Glasgow score; NIHSS: National Institute of Health stroke scale.

Table 2 Predictive performance of radiological models, clinical model and clinical-radiological model in prediction of early enlargement of spontaneous intracerebral hemorrhage on patients in the testing cohort

Model	ROI	AUC (95%CI)	Accuracy	Sensitivity	Specificity	PPV	NPV	F1 score	Brier score
Xception	Hemorrhage	0.638 (0.526-0.750)	61.86	68.57	58.06	48.00	76.60	0.565	0.507
	Perihematomal edema	0.641 (0.529-0.753)	62.89	65.71	61.29	48.94	76.00	0.561	0.535
	Combined	0.648 (0.535-0.761)	61.86	54.29	66.13	47.50	71.93	0.507	0.865
VGG16	Hemorrhage	0.647 (0.535-0.759)	63.92	34.29	80.65	50.00	68.49	0.407	0.517
	Perihematomal edema	0.607 (0.501-0.720)	57.73	45.71	64.52	42.11	67.80	0.438	0.442
	Combined	0.679 (0.567-0.791)	59.79	88.57	43.55	46.97	87.10	0.614	0.519
VGG19	Hemorrhage	0.571 (0.500-0.683)	58.76	68.57	53.23	45.28	75.00	0.545	0.402
	Perihematomal edema	0.667 (0.555-0.779)	60.82	80.00	50.00	47.46	81.58	0.596	0.523
	Combined	0.725 (0.613-0.837)	68.04	80.00	61.29	53.85	84.44	0.644	0.551
ResNet50	Hemorrhage	0.747 (0.636-0.858)	63.92	82.86	53.23	50.00	84.62	0.624	0.686
	Perihematomal edema	0.659 (0.547-0.771)	46.39	71.43	32.26	37.31	66.67	0.490	0.575
	Combined	0.774 (0.662-0.886)	60.82	88.57	45.16	47.69	87.50	0.620	0.703
InceptionV3	Hemorrhage	0.620 (0.511-0.729)	55.67	74.29	45.16	43.33	75.68	0.547	0.491
	Perihematomal edema	0.637 (0.528-0.746)	56.70	65.71	51.61	43.40	72.73	0.523	0.549
	Combined	0.704 (0.592-0.816)	62.89	68.57	59.68	48.98	77.08	0.571	0.587
InceptionResNetV2	Hemorrhage	0.663 (0.552-0.774)	69.07	54.29	77.42	57.58	75.00	0.559	0.549
	Perihematomal edema	0.683 (0.571-0.795)	53.61	77.14	40.32	42.19	75.76	0.545	0.628
	Combined	0.728 (0.615-0.841)	64.95	82.86	54.84	50.88	85.00	0.630	0.588
Handcrafted radiomics	Hemorrhage	0.564 (0.502-0.626)	53.61	40.00	61.29	36.84	64.41	0.384	0.446
	Perihematomal edema	0.507 (0.500-0.563)	55.67	68.57	48.39	42.86	73.17	0.527	0.358
	Combined	0.635 (0.527-0.743)	54.64	62.86	50.00	41.51	70.45	0.500	0.579
Radiological model	-	0.713 (0.600-0.826)	72.16	60.00	79.03	61.76	77.78	0.609	0.576
Clinical model	-	0.534 (0.501-0.567)	55.67	45.71	61.29	40.00	66.67	0.427	0.414
Integrated model	-	0.828 (0.714-0.942)	72.89	70.00	74.52	58.84	84.07	0.638	0.749

CI: Confidence interval; ROI: Region of interest; AUC: Area under the receiver operating characteristic curve; PPV: Positive predictive value; NPV: Negative predictive value.

Table 3 Predictive performance of radiological models, clinical model and clinical-radiological model in prediction of hospital death on patients in the testing cohort

Model	ROI	AUC (95%CI)	Accuracy	Sensitivity	Specificity	PPV	NPV	F1 score	Brier score
Xception	Hemorrhage	0.517 (0.501-0.533)	70.10	50.00	72.41	17.24	92.65	0.256	0.132
	Perihematomal edema	0.513 (0.508-0.520)	64.95	30.00	68.97	10.00	89.55	0.150	0.103
	Combined	0.549 (0.510-0.588)	76.29	30.00	81.61	15.79	91.03	0.207	0.153
VGG16	Hemorrhage	0.580 (0.528-0.632)	57.73	40.00	59.77	10.26	89.66	0.163	0.249
	Perihematomal edema	0.584 (0.523-0.645)	57.73	20.00	62.07	5.71	87.10	0.089	0.092
	Combined	0.607 (0.532-0.682)	75.26	30.00	80.46	15.00	90.91	0.200	0.154
VGG19	Hemorrhage	0.586 (0.555-0.617)	63.92	30.00	67.82	89.68	89.39	0.146	0.099
	Perihematomal edema	0.606 (0.564-0.648)	67.01	10.00	73.56	4.17	87.67	0.059	0.092
	Combined	0.654 (0.567-0.741)	68.04	20.00	73.56	8.00	88.89	0.114	0.106
ResNet50	Hemorrhage	0.570 (0.510-0.630)	67.01	40.00	70.11	13.33	91.04	0.200	0.173
	Perihematomal edema	0.561 (0.512-0.610)	71.13	50.00	73.56	17.86	92.75	0.263	0.149
	Combined	0.705 (0.606-0.804)	64.95	60.00	65.52	16.67	93.44	0.261	0.254
InceptionV3	Hemorrhage	0.508 (0.500-0.517)	72.16	40.00	75.86	16.00	91.67	0.229	0.309
	Perihematomal edema	0.517 (0.509-0.525)	62.89	40.00	65.52	11.76	90.48	0.182	0.120
	Combined	0.547 (0.516-0.578)	68.04	50.00	70.11	16.13	92.42	0.244	0.142
InceptionResNetV2	Hemorrhage	0.502 (0.500-0.508)	65.98	30.00	70.11	10.34	89.71	0.154	0.136
	Perihematomal edema	0.597 (0.535-0.659)	72.16	40.00	75.86	16.00	91.67	0.229	0.262
	Combined	0.615 (0.540-0.690)	70.10	60.00	71.26	19.35	93.94	0.293	0.189
Handcrafted radiomics	Hemorrhage	0.600 (0.546-0.654)	70.10	60.00	71.26	19.35	93.94	0.293	0.223
	Perihematomal edema	0.516 (0.505-0.527)	57.73	30.00	60.92	8.11	88.33	0.128	0.127
	Combined	0.603 (0.534-0.672)	67.01	50.00	68.97	15.63	92.31	0.238	0.168
Hematoma expansion	-	0.546 (0.524-0.568)	65.98	30.00	70.11	10.34	89.71	0.154	0.158
Radiological model	-	0.655 (0.576-0.734)	67.01	30.00	71.26	10.71	89.86	0.158	0.208
Integrated model	-	0.754 (0.646-0.862)	71.13	60.00	72.41	20.00	94.03	0.300	0.241

CI: Confidence interval; ROI: Region of interest; AUC: Area under the receiver operating characteristic curve; PPV: Positive predictive value; NPV: Negative predictive value.