Detection and Localization of Subdural Hematoma Using Deep Learning on Computed Tomography

TL;DR

This study presents a multimodal deep learning system that accurately detects and localizes subdural hematomas in CT scans, combining clinical data and imaging for improved interpretability and performance.

Contribution

The paper introduces a novel multimodal deep learning framework that integrates clinical variables, 3D CNNs, and transformer-based segmentation for SDH detection and localization.

Findings

Achieved high detection accuracy with AUC 0.9407.

Multimodal ensemble outperformed individual models.

Generated anatomically meaningful localization maps.

Abstract

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.