A Fully Automated Pipeline Using Swin Transformers for Deep Learning-Based Blood Segmentation on Head Computed Tomography Scans After Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: Accurate volumetric assessment of spontaneous aneurysmal subarachnoid hemorrhage (aSAH) is a labor-intensive task performed with current manual and semiautomatic methods that might be relevant for its clinical and prognostic implications. In the present research, we sought to develop and validate an artificial intelligence-driven, fully automated blood segmentation tool for subarachnoid hemorrhage (SAH) patients via non- contrast computed tomography (NCCT) scans employing a transformer-based Swin-UNETR architecture. METHODS: We retrospectively analyzed NCCT scans from patients with confirmed aSAH utilizing the SwinUNETR for segmentation. The performance of the proposed method was evaluated against manually segmented ground truth data using metrics such as Dice score, intersection over union, volumetric similarity index , symmetric average surface distance , sensitivity, and specificity. A validation cohort from an external institution was included to test the generalizability of the model. RESULTS: The model demonstrated high accuracy with robust performance metrics across the internal and external validation cohorts. Notably, it achieved high Dice coefficient (0.873 +/- 0.097), intersection over union (0.810 +/- 0.092), volumetric similarity index (0.840 +/- 0.131), sensitivity (0.821 +/- 0.217), and specificity (0.996 +/- 0.004) values and a low symmetric average surface distance (1.866 +/- 2.910), suggesting proficiency in segmenting blood in SAH patients. The model's efficiency was reflected in its processing speed, indicating potential for real-time applications. CONCLUSIONS: Our Swin UNETR-based model offers significant advances in the automated segmentation of blood in SAH patients on NCCT images. Despite the computational demands, the model operates effectively on standard hardware with a user-friendly interface, facilitating broader clinical adoption. Further validation across diverse datasets is warranted to confirm its clinical reliability.