Subdural Hematoma on CT

Purpose	Detect, classify and measure the size of a subdural hematoma or collection
Tag(s)
Panel	Neuroradiology Panel
Define-AI ID	19020003
Originator	John Tsiouris
Lead	John Tsiouris
Panel Chair	Alex Norbash
Panel Reviewers	Neuroradiology Panel
License	Creative Commons 4.0
Status	Public Comment
RadElement Set	RDES128

Clinical Implementation

Value Proposition

Subdural hematomas and collections are very common and can be traumatic or atraumatic; they predominantly occur in the elderly and in patients with bleeding diatheses, although they can occur in patients of any demographic. They can also be seen in patients with brain infections, inflammatory diseases, and intracranial hypotension. They compress the adjacent brain and can cause midline shift and central downward brain herniation, leading to increased intracranial pressure (ICP), brainstem compression and death if untreated. Subdural hematomas and collections are critical to identify and manage as quickly as possible, since they may bleed, rebleed, and increase in size. Identifying them quickly can significantly improve patient outcomes. In emergency situations, automated identification and classification of subdural hematomas or collections would assist case prioritization and interpretation. In busy private practices, outpatient CT scans that potentially demonstrate subdural hematomas/collections may not be reviewed for days after completion, delaying management and potentially leading to poor patient outcomes. Automated identification and classification would also provide value to non-specialists, especially those who read images in emergency situations.

Narrative

An 88-year-old woman is seen by her primary care physician on a Friday afternoon; she complains of a worsening headache over the past 4 days. She doesn’t remember any head trauma or falling down, but she did bump her head on a car door a few days back. She has no focal neurological complaints. Her neurological exam is normal. Her physician sends her for an outpatient CT scan that afternoon at the closest imaging center.

Workflow Description

Patient receives a CT or MRI scan of their head; the clinical indications can be numerous. Algorithm receives entire CT or MRI dataset. If the algorithm can determine a result, return: size, location (R/L; frontal/parietal/temporal/occipital/parafalcine/cerebellar), the density of the subdural hematoma/collection. A reliability metric, assessing the accuracy of the size measurement, would also be helpful. An alert should notify the user.
Additional considerations are as follows: Algorithm executes after exam is verified on PACS in the backend. Algorithm optimally integrates on PACS and dictation or reporting software. The user is able to automatically populate the report or manually input the results. Indicator image may save to PACS as part of the medical record.

Considerations for Dataset Development

Patient Age (years)	[0,100]
Sex at birth	Male, Female
Hematoma	Absent, present
Dural thickening	Absent, present
Location	R/L; frontal/parietal/temporal/occipital/parafalcine/cerebellar

Technical Specifications

Inputs

DICOM Study

Procedure	CT, Head
Views	All
Data Type	DICOM
Modality	CT
Body Region	Head
Anatomic Focus	Brain

Primary Outputs

Hematoma Shape/Configuration

RadElement ID	RDE838
Definition	Shape/configuration of extra-axial hematoma/collection
Data Type	Categorical
Value Set	Undetermined Crescentic Lentiform
Units	N/A

Hematoma Laterality

RadElement ID	RDE839
Definition	Laterality of extra-axial hematoma/collection
Data Type	Categorical
Value Set	Undetermined Unilateral Bilateral
Units	N/A

Hematoma Location

RadElement ID	RDE840
Definition	Location of extra-axial hematoma/collection
Data Type	Categorical
Value Set	Undetermined Frontal Parietal Temporal Occipital Parafalcine Cerebellar Multiple locations
Units	N/A

Hematoma Width

RadElement ID	RDE841
Definition	Maximum width of extra-axial hematoma/collection (mm)
Data Type	Numeric
Value Set	[0,40]
Units	mm

Hematoma Volume

RadElement ID	RDE842
Definition	Volume of extra-axial hematoma (mm3)
Data Type	Numeric
Value Set	[0,200]
Units	mm3

Hematoma Density

RadElement ID	RDE843
Definition	Density of extra-axial hematoma/collection
Data Type	Categorical
Value Set	Indeterminate High homogeneous Low homogeneous High heterogeneous Low heterogeneous
Units	N/A

Hematoma Septations

RadElement ID	RDE846
Definition	Presence of extra-axial hematoma septations
Data Type	Categorical
Value Set	Indeterminate Present Absent
Units	N/A

Related Datasets

No known related public datasets at this time, please alert us if you know of any.