Clinical, radiological, and radiomics feature-based explainable machine learning models for prediction of neurological deterioration and 90-day outcomes in mild intracerebral hemorrhage.

Background: The risks and prognosis of mild intracerebral hemorrhage (ICH) patients were easily overlooked by clinicians. Our goal was to use machine learning (ML) methods to predict mild ICH patients' neurological deterioration (ND) and 90-day prognosis.

Methods: This prospective study recruited 257 patients with mild ICH for this study. After exclusions, 148 patients were included in the ND study and 144 patients in the 90-day prognosis study. We trained five ML models using filtered data, including clinical, traditional imaging, and radiomics indicators based on non-contrast computed tomography (NCCT). Additionally, we incorporated the Shapley Additive Explanation (SHAP) method to display key features and visualize the decision-making process of the model for each individual.

Results: A total of 21 (14.2%) mild ICH patients developed ND, and 35 (24.3%) mild ICH patients had a 90-day poor prognosis. In the validation set, the support vector machine (SVM) models achieved an AUC of 0.846 (95% confidence intervals (CI), 0.627-1.000) and an F1-score of 0.667 for predicting ND, and an AUC of 0.970 (95% CI, 0.928-1.000), and an F1-score of 0.846 for predicting 90-day prognosis. The SHAP analysis results indicated that several clinical features, the island sign, and the radiomics features of the hematoma were of significant value in predicting ND and 90-day prognosis.

Conclusion: The ML models, constructed using clinical, traditional imaging, and radiomics indicators, demonstrated good classification performance in predicting ND and 90-day prognosis in patients with mild ICH, and have the potential to serve as an effective tool in clinical practice.

Clinical trial number: Not applicable.