Subdural Hematoma on MRI

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 Commenting
RadElement Set RDES128 
                               

Clinical Implementation


Value Proposition

Subdural hematomas and collections are very common and can be traumatic or atraumatic; they predominately 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 MRI 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 MRI that afternoon at the closest imaging center.

Workflow Description

Patient receives a MRI scan of their head; the clinical indications can be numerous. Algorithm receives entire MRI dataset. If the algorithm can determine a result, return: size, location (R/L; frontal/parietal/temporal/occipital/parafalcine/cerebellar), intensity 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]

Procedures

MRI scan or the brain; with or without contrast

Sex at birth

Male, Female

Hematoma

Absent, present

Dural thickening

Absent, present

T1 Intensity

Varied

T2 Intensity

Varied

Location

R/L; frontal/parietal/temporal/occipital/parafalcine/cerebellar

Technical Specifications


Inputs

DICOM Study

Procedure

MRI, Head

Views

All

Data Type

DICOM

Modality

MR

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

Location 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 T1 Intensity

RadElement ID

RDE844

Definition

Intensity of extra-axial hematoma/collection

Data Type

Numeric

Value Set

[0,1000]

Units

MR units

Hematoma T2 Intensity

RadElement ID

RDE845

Definition

Intensity of extra-axial hematoma/collection

Data Type

Numeric

Value Set

[0,1000]

Units

MR units

Hematoma Septations

RadElement ID

RDE846

Definition

Presence of extra-axial hematoma septations

Data Type

Categorical

Value Set

  • Indeterminate
  • Present
  • Absent

Units

N/A