Annotation-free deep learning for detection and segmentation of fetal germinal matrix-intraventricular hemorrhage in brain MRI
Prenatal germinal matrix-intraventricular hemorrhage (GMH-IVH) is a leading cause of infant mortality and neurodevelopmental impairment, yet its manual diagnosis and lesion segmentation on fetal brain MRI are labor-intensive and error-prone. Although supervised deep learning offers potential for automation, it typically requires large amounts of annotated GMH-IVH data, which are challenging to obtain for such a rare condition (0.5-0.9 per 1000 pregnancies). To address these problems, an annotation-free deep learning framework, FreeHemoSeg, was developed for automated detection and segmentation of GMH-IVH without any real patient annotations. Instead of learning from expert labels, FreeHemoSeg was trained on pseudo GMH-IVH images synthesized from normal fetal data guided by medical priors. The framework was evaluated in a retrospective multicentre study of 1,674 stacks of 2D T2-weighted MRI from 558 pregnant women, using data from one hospital for internal training and validation and two hospitals for external validation. FreeHemoSeg achieved the highest diagnostic and segmentation performance in both internal validation (AUROC: 0.959; AUPR: 0.928; sensitivity: 0.914; specificity: 0.966; DSC: 0.559) and external validation (AUROC: 0.930; AUPR: 0.884; sensitivity: 0.824; specificity: 0.943; DSC: 0.512), outperforming a supervised model trained on limited empirical data and unsupervised anomaly detection methods. Moreover, FreeHemoSeg assistance improved radiologists' sensitivity (from 0.882 to 0.941-1.000) and diagnostic confidence, while reducing interpretation time by 16.0-52.7%. We anticipate its immediate utility in supporting earlier diagnosis, prognostic counselling, and perinatal planning for fetal GMH-IVH. Code: https://github.com/Arktis2022/FreeHemoSeg.