Deep Learning-Based Detection of Intracranial Hemorrhages in Postmortem Computed Tomography: Comparative Study of 15 Transfer-Learned Models

With the increasing use of postmortem imaging, deep learning (DL)-based automated analysis may assist in the detection of intracranial hemorrhages. However, limited postmortem data complicate model training. This study aims to assess the accuracy of DL models in detecting intracranial hemorrhages in postmortem head computed tomography (CT) scans using transfer learning. A total of 75,000 labeled head CT images from the Radiological Society of North America Intracranial Hemorrhage Detection Challenge serve as the training data for the 15 DL models. Each model is fine-tuned via transfer learning. A total of 134 postmortem cases with hemorrhage status confirmed by autopsy serve as the external test set. Model performance is evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, training time, inference time, and number of parameters. Spearman’s rank correlation coefficients are calculated for these metrics. DenseNet201 achieves the highest AUC (0.907), with the AUCs of the 15 models ranging from 0.862 to 0.907. A longer inference time moderately correlates with higher AUC (Spearman’s ρ = 0.586, p = 0.022), whereas the number of parameters is not positively correlated with performance (ρ = −0.472, p = 0.076). The sensitivity and specificity are 0.828 and 0.871, respectively. Transfer learning using a large non-postmortem dataset enables accurate intracranial hemorrhage detection using postmortem CT, potentially reducing the autopsy workload. The results demonstrate that models with fewer parameters often perform comparably to more complex models, emphasizing the need to balance accuracy with computational efficiency.