Aortic Dissection Detection nnU-Net

nnU-Net-based pipeline for automated detection and sub-classification of acute thoracic aortic dissection (AD) on heterogeneous CT imaging, formulated as a semantic segmentation task rather than direct image classification. The model segments the false lumen (ascending and descending) and the dissection membrane -- along with optional indirect signs such as hemopericardium, aortic wall hematoma, and supra-aortic branch dissection -- and a patient is classified as AD-positive if at least two of the three primary segmented regions exceed a volume threshold tuned via Youden's index; the same pipeline additionally flags Stanford type A dissections. Trained on 157 heterogeneous internal CT studies (not restricted to a single contrast protocol) from Mannheim University Medical Centre and evaluated on an internal held-out test set as well as public external datasets (ImageTBAD and AVT), the model reached an AUROC of 98.7% internally and 97.0% externally, and correctly flagged 93.3% of dissection cases that had not been clinically suspected before imaging. The authors state the trained network will be made publicly available as a non-medical device for further scientific research.