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. 2025 May 17.
doi: 10.1007/s00330-025-11666-2. Online ahead of print.

Development of a deep-learning algorithm for etiological classification of subarachnoid hemorrhage using non-contrast CT scans

Lingxu Chen  1   2 , Xiaochen Wang  1   2 , Yuanjun Li  3 , Yang Bao  4 , Sihui Wang  1 , Xuening Zhao  1 , Mengyuan Yuan  1 , Jianghe Kang  3 , Shengjun Sun  5   6
Affiliations

Development of a deep-learning algorithm for etiological classification of subarachnoid hemorrhage using non-contrast CT scans

Lingxu Chen et al. Eur Radiol. .

Abstract

Objectives: This study aims to develop a deep learning algorithm for differentiating aneurysmal subarachnoid hemorrhage (aSAH) from non-aneurysmal subarachnoid hemorrhage (naSAH) using non-contrast computed tomography (NCCT) scans.

Methods: This retrospective study included 618 patients diagnosed with SAH. The dataset was divided into a training and internal validation cohort (533 cases: aSAH = 305, naSAH = 228) and an external test cohort (85 cases: aSAH = 55, naSAH = 30). Hemorrhage regions were automatically segmented using a U-Net + + architecture. A ResNet-based deep learning model was trained to classify the etiology of SAH.

Results: The model achieved robust performance in distinguishing aSAH from naSAH. In the internal validation cohort, it yielded an average sensitivity of 0.898, specificity of 0.877, accuracy of 0.889, Matthews correlation coefficient (MCC) of 0.777, and an area under the curve (AUC) of 0.948 (95% CI: 0.929-0.967). In the external test cohort, the model demonstrated an average sensitivity of 0.891, specificity of 0.880, accuracy of 0.887, MCC of 0.761, and AUC of 0.914 (95% CI: 0.889-0.940), outperforming junior radiologists (average accuracy: 0.836; MCC: 0.660).

Conclusion: The study presents a deep learning architecture capable of accurately identifying SAH etiology from NCCT scans. The model's high diagnostic performance highlights its potential to support rapid and precise clinical decision-making in emergency settings.

Key points: Question Differentiating aneurysmal from naSAH is crucial for timely treatment, yet existing imaging modalities are not universally accessible or convenient for rapid diagnosis. Findings A ResNet-variant-based deep learning model utilizing non-contrast CT scans demonstrated high accuracy in classifying SAH etiology and enhanced junior radiologists' diagnostic performance. Clinical relevance AI-driven analysis of non-contrast CT scans provides a fast, cost-effective, and non-invasive solution for preoperative SAH diagnosis. This approach facilitates early identification of patients needing aneurysm surgery while minimizing unnecessary angiography in non-aneurysmal cases, enhancing clinical workflow efficiency.

Keywords: Computed tomography; Deep learning; Intracranial aneurysm; Subarachnoid hemorrhage.

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Conflict of interest statement

Compliance with ethical standards. Guarantor: The scientific guarantor of this publication is Shengjun Sun. Conflict of interest: Y.B. is employed by Neusoft Medical Systems, Co. Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Statistics and biometry: No complex statistical methods were necessary for this paper. Informed consent: Written informed consent was waived by the Institutional Review Board. Ethical approval: Institutional Review Board approval was obtained. Study subjects or cohorts overlap: No study subjects or cohorts have been previously reported. Methodology: Retrospective Diagnostic or prognostic study Multicenter study

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