Ashraya K. Indrakanti, Jakob Wasserthal, Martin Segeroth et al.
Purpose: To develop an open-source nnU-Net-based AI model for combined detection and segmentation of unruptured intracranial aneurysms (UICA) in 3D TOF-MRI, and compare models trained on datasets with aneurysm-like differential diagnoses. Methods: This retrospective study (2020-2023) included 385 anonymized 3D TOF-MRI images from 364 patients (mean age 59 years, 60% female) at multiple centers plus 113 subjects from the ADAM challenge. Images featured untreated or possible UICAs and differential diagnoses. Four distinct training datasets were created, and the nnU-Net framework was used for model development. Performance was assessed on a separate test set using sensitivity and False Positive (FP)/case rate for detection, and DICE score and NSD (Normalized Surface Distance) with a 0.5mm threshold for segmentation. Statistical analysis included chi-square, Mann-Whitney-U, and Kruskal-Wallis tests, with significance set at p < 0.05. Results: Models achieved overall sensitivity between 82% and 85% and a FP/case rate of 0.20 to 0.31, with no significant differences (p = 0.90 and p = 0.16). The primary model showed 85% sensitivity and 0.23 FP/case rate, outperforming the ADAM-challenge winner (61%) and a nnU-Net trained on ADAM data (51%) in sensitivity (p < 0.05). It achieved a mean DICE score of 0.73 and an NSD of 0.84 for correctly detected UICA. Conclusions: Our open-source, nnU-Net-based AI model (available at 10.5281/zenodo.13386859) demonstrates high sensitivity, low false positive rates, and consistent segmentation accuracy for UICA detection and segmentation in 3D TOF-MRI, suggesting its potential to improve clinical diagnosis and for monitoring of UICA.