A Resource-Efficient Hybrid Deep Learning Framework with External Validation for Intracranial Hemorrhage Detection in CT Scans

Abstract

Background: Intracranial hemorrhage (ICH) is a time-critical neurological emergency in which delayed diagnosis significantly worsens patient outcomes. This challenge is amplified in resource-limited, high-workload settings where rapid neuroimaging interpretation may be constrained. Many high-performing deep learning approaches for disease detection rely on large-scale models trained on extensive data and evaluated only on internal datasets, limiting their generalization across heterogeneous clinical environments. This study aims to develop and evaluate a resource-efficient framework for automated ICH detection from CT scans, with internal and external validation across heterogeneous clinical settings. Methods: A hybrid deep learning framework was developed, combining an EfficientNetV2-S-based feature extractor with a bidirectional GRU model for scan-level prediction. The model was trained on a stratified subset of 6000 CT scans from the RSNA Intracranial Hemorrhage Detection dataset and evaluated using an internal test set and two external validation cohorts (PhysioNet and CQ500). Results: On an internal held-out test set, the model achieved scan-level AUROC and AUPRC of 0.980 and 0.977, respectively, and slice-level AUROC and AUPRC of 0.981 and 0.923. External validation on the PhysioNet and CQ500 datasets yielded scan-level AUROC/AUPRC values of 0.914/0.932 and 0.905/0.909, respectively, demonstrating consistent performance across datasets differing in institution, geography, patient population, and acquisition protocols. Conclusions: Despite its compact architecture and reduced training subset, the proposed framework achieves performance competitive with substantially larger and more computationally demanding models, completing training in under 26 h on single-GPU hardware. These results support the feasibility of reproducible, resource-efficient ICH detection systems for automated triage in emergency radiology workflows across different clinical settings.