Prediction of hematoma expansion in spontaneous intracerebral hemorrhage using a multimodal neural network

Abstract

Hematoma expansion occasionally occurs in patients with intracerebral hemorrhage (ICH), associating with poor outcome. Multimodal neural networks incorporating convolutional neural network (CNN) analysis of images and neural network analysis of tabular data are known to show promising results in prediction and classification tasks. We aimed to develop a reliable multimodal neural network model that comprehensively analyzes CT images and clinical variables to predict hematoma expansion. We retrospectively enrolled ICH patients at four hospitals between 2017 and 2021, assigning patients from three hospitals to the training and validation dataset and patients from one hospital to the test dataset. Admission CT images and clinical variables were collected. CT findings were evaluated by experts. Three types of models were developed and trained: (1) a CNN model analyzing CT images, (2) a multimodal CNN model analyzing CT images and clinical variables, and (3) a non-CNN model analyzing CT findings and clinical variables with machine learning. The models were evaluated on the test dataset, focusing first on sensitivity and second on area under the receiver operating curve (AUC). Two hundred seventy-three patients (median age, 71 years [59–79]; 159 men) in the training and validation dataset and 106 patients (median age, 70 years [62–82]; 63 men) in the test dataset were included. Sensitivity and AUC of a CNN model were 1.000 (95% confidence interval [CI] 0.768–1.000) and 0.755 (95% CI 0.704–0.807); those of a multimodal CNN model were 1.000 (95% CI 0.768–1.000) and 0.799 (95% CI 0.749–0.849); and those of a non-CNN model were 0.857 (95% CI 0.572–0.982) and 0.733 (95% CI 0.625–0.840). We developed a multimodal neural network model incorporating CNN analysis of CT images and neural network analysis of clinical variables to predict hematoma expansion in ICH. The model was externally validated and showed the best performance of all the models.