Deepening the Diagnosis: Detection of Midline Shift Using an Advanced Deep Learning Architecture

Midline shift (MLS) is one of the conditions that strongly affects mortality and prognosis in critical neurological emergencies such as traumatic brain injury (TBI). Especially, MLS over 5 mm requires urgent diagnosis and treatment. Despite widespread tomography imaging capabilities, the lack of radiologists capable of interpreting the images causes delays in the diagnosis process. Therefore, there is a need for AI-supported diagnostic systems specifically tailored to the field for MLS detection. However, the lack of open, disorder-specific datasets in the literature has limited research in the field and hindered the ability to make comparisons against a reliable reference point. Therefore, the current state of deep learning (DL) methods in the field is not sufficiently addressed. Within the scope of this study, a DL architecture is proposed for MLS detection as a classification task, with millimeter-scale MLS measurements used for evaluation and stratified analysis. This process also comprehensively addresses the status of MLS detection in contemporary DL architecture. Furthermore, to address the lack of open datasets in the literature, two publicly available datasets originally collected with a primary focus on TBI have been annotated for MLS detection. The proposed model was tested on two different open datasets and achieved mean sensitivity values of 0.9467–0.9600 for the Radiological Society of North America (RSNA) dataset and 0.8623–0.8984 for the CQ500 dataset in detecting MLS presence above 5 mm across two different scenarios. It achieved a mean Area Under the Curve-Receiver Operating Characteristic (AUC-ROC) value of 0.9219–0.9816 for the RSNA dataset and 0.9443–0.9690 for the CQ500 dataset. The aim of the study is to detect not only emergency cases but also small MLSs independent of quantity for patient follow-up, so the overall performance of the proposed model (MLS present/absent) was calculated without an MLS quantity threshold. Mean F1 Score values of 0.7403 for the RSNA dataset and 0.7271 for the CQ500 dataset were obtained, along with mean AUC-ROC values of 0.8941 for the RSNA dataset and 0.9301 for the CQ500 dataset. The study presents a clinically applicable, optimized, fast, reliable, up-to-date, and successful DL solution for the rapid diagnosis of MLS, intervention in emergencies, and monitoring of small MLS. It also contributes to the literature by enabling a high level of reproducibility in the scientific community with labeled open data.