Introduction: Detection of acute intracranial hemorrhage (AIH) is a primary task in image interpretation of computer tomography (CT) of brain for patients suffering from acute neurological disturbance or head injury. Although CT readily depicts AIH, interpretation can be difficult especially when the lesion is inconspicuous or the reader is inexperienced.
Objective: To develop a computer aided detection system that improves diagnostic accuracy of small AIH on brain CT.
Materials and methods: Intracranial contents are first segmented by thresholding and morphological operations, which are then subjected to denoising and adjustment for CT cupping artifacts. The brain is then automatically realigned into normal position. AIH candidates are extracted based on top-hat transformation and left-right asymmetry. AIH candidates are registered against a normalized coordinate system such that the candidates are rendered anatomical information. True AIH is differentiated from mimicking normal variants or artifacts by a knowledge-based classification system incorporating rules that make use of quantified imaging features and anatomical information. A total of 186 clinical cases, including 62 CT studies showing small (<1cm) AIH, and 124 controls, were retrospectively collected. Forty positive cases and 80 controls were used for the training of the CAD. Twenty-two positive cases and 44 controls were used in the validation of the CAD system. Regions of AIH identified by two experienced radiologists were used as gold standard. The size of individual AIH volume was also recorded.
Results: On a per patient basis, the system achieved sensitivity of 95% (38/40) and specificity of 88.8% (71/80) in the training dataset. The sensitivity and specificity were 100% (22/22) and 84.1% (37/44) respectively for the diagnosis of AIH in the validation cases. Individual cases contained variable number of AIH volumes. There were 77 lesions in the 40 training cases and 46 lesions in the 22 validation cases. On a per lesion basis, the sensitivities were 84.4% (65/77) and 82.6% (38/46) for all lesions 10mm or smaller for the training and validation datasets, respectively. False positive rates were 0.19 (23/120) and 0.29 (19/66) false positive lesion per case for the training and validation datasets, respectively.
Conclusion: This study demonstrated that CAD is valuable for detection of small AIH on brain CT.