Edinburgh Imaging

25 Nov 23. Featured Paper

Evaluating artificial intelligence software for delineating hemorrhage extent on CT brain imaging in stroke

Link to paper on Journal of Stroke and Cerebrovascular Diseases


Adam Vacek , Grant Mair, MD, Philip White, MD , Philip M Bath, DSc, Keith W Muir, MD , Rustam Al-Shahi Salman, PhD, Chloe Martin, David Dye, Francesca M Chappell, PhD, Rüdiger von Kummer , Malcolm Macleod, PhD , Nikola Sprigg, DM , Joanna M Wardlaw, MD



The extent and distribution of intracranial hemorrhage (ICH) directly affects clinical management. Artificial intelligence (AI) software can detect and may delineate ICH extent on brain CT. We evaluated e-ASPECTS software (Brainomix Ltd.) performance for ICH delineation.


We qualitatively assessed software delineation of ICH on CT using patients from six stroke trials. We assessed hemorrhage delineation in five compartments: lobar, deep, posterior fossa, intraventricular, extra-axial. We categorized delineation as excellent, good, moderate, or poor. We assessed quality of software delineation with number of affected compartments in univariate analysis (Kruskall-Wallis test) and ICH location using logistic regression (dependent variable: dichotomous delineation categories ‘excellent-good’ versus ‘moderate-poor’), and report odds ratios (OR) and 95 % confidence intervals (95 %CI).


From 651 patients with ICH (median age 75 years, 53 % male), we included 628 with assessable CTs. Software delineation of ICH extent was ‘excellent’ in 189/628 (30 %), ‘good’ in 255/628 (41 %), ‘moderate’ in 127/628 (20 %), and ‘poor’ in 57/628 cases (9 %). The quality of software delineation of ICH was better when fewer compartments were affected (Z = 3.61-6.27; p = 0.0063). Software delineation of ICH extent was more likely to be ‘excellent-good’ quality when lobar alone (OR = 1.56, 95 %CI = 0.97-2.53) but ‘moderate-poor’ with any intraventricular (OR = 0.56, 95 %CI = 0.39-0.81, p = 0.002) or any extra-axial (OR = 0.41, 95 %CI = 0.27-0.62, p<0.001) extension.


Delineation of ICH extent on stroke CT scans by AI software was excellent or good in 71 % of cases but was more likely to over- or under-estimate extent when ICH was either more extensive, intraventricular, or extra-axial.




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Featured Paper: Evaluating artificial intelligence software for delineating hemorrhage extent on CT brain imaging in stroke

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