Automated anatomy-based post-processing reduces false positives and improved interpretability of deep learning intracranial aneurysm detection

Introduction: Deep learning (DL) models can help detect intracranial aneurysms on CTA, but high false positive (FP) rates remain a barrier to clinical translation, despite improvement in model architectures and strategies like detection threshold tuning. We employed an automated, anatomy-based, heuristic-learning hybrid artery-vein segmentation post-processing method to further reduce FPs. Methods: Two DL models, CPM-Net and a deformable 3D convolutional neural network-transformer hybrid (3D-CNN-TR), were trained with 1,186 open-source CTAs (1,373 annotated aneurysms), and evaluated with 143 held-out private CTAs (218 annotated aneurysms). Brain, artery, vein, and cavernous venous sinus (CVS) segmentation masks were applied to remove possible FPs in the DL outputs that overlapped with: (1) brain mask; (2) vein mask; (3) vein more than artery masks; (4) brain plus vein mask; (5) brain plus vein more than artery masks. Results: CPM-Net yielded 139 true-positives (TP); 79 false-negative (FN); 126 FP. 3D-CNN-TR yielded 179 TP; 39 FN; 182 FP. FPs were commonly extracranial (CPM-Net 27.3%; 3D-CNN-TR 42.3%), venous (CPM-Net 56.3%; 3D-CNN-TR 29.1%), arterial (CPM-Net 11.9%; 3D-CNN-TR 53.3%), and non-vascular (CPM-Net 25.4%; 3D-CNN-TR 9.3%) structures. Method 5 performed best, reducing CPM-Net FP by 70.6% (89/126) and 3D-CNN-TR FP by 51.6% (94/182), without reducing TP, lowering the FP/case rate from 0.88 to 0.26 for CPM-NET, and from 1.27 to 0.62 for the 3D-CNN-TR. Conclusion: Anatomy-based, interpretable post-processing can improve DL-based aneurysm detection model performance. More broadly, automated, domain-informed, hybrid heuristic-learning processing holds promise for improving the performance and clinical acceptance of aneurysm detection models.

Anatomically-guided masked autoencoder pre-training for aneurysm detection

Intracranial aneurysms are a major cause of morbidity and mortality worldwide, and detecting them manually is a complex, time-consuming task. Albeit automated solutions are desirable, the limited availability of training data makes it difficult to develop such solutions using typical supervised learning frameworks. In this work, we propose a novel pre-training strategy using more widely available unannotated head CT scan data to pre-train a 3D Vision Transformer model prior to fine-tuning for the aneurysm detection task. Specifically, we modify masked auto-encoder (MAE) pre-training in the following ways: we use a factorized self-attention mechanism to make 3D attention computationally viable, we restrict the masked patches to areas near arteries to focus on areas where aneurysms are likely to occur, and we reconstruct not only CT scan intensity values but also artery distance maps, which describe the distance between each voxel and the closest artery, thereby enhancing the backbone's learned representations. Compared with SOTA aneurysm detection models, our approach gains +4-8% absolute Sensitivity at a false positive rate of 0.5. Code and weights will be released.