Utilizing Artificial Intelligence for CSF Segmentation and Analysis in Head CT Imaging: A Systematic Review

Abstract

Background: The intracranial space has limited capacity; thus, volume changes in any component can raise intracranial pressure and cause mass effect. This mechanism underlies many neurological disorders. Artificial Intelligence, increasingly applied in medicine and diagnostic imaging, may support the evaluation of such conditions. This systematic review investigates AI-based models for cerebrospinal fluid segmentation and analysis on computed tomography. Methods: In December 2024, a systematic review was conducted across MEDLINE (PubMed), Scopus, Web of Science, Embase, and Cochrane Library. From 559 identified studies, 14 were included after independent review by two evaluators. Extracted data covered study characteristics, AI model design, dataset composition, and performance metrics for CSF segmentation. Quality assessment followed PRISMA 2020 and used JBI, AMSTAR 2, and CASP checklists. Results: The 14 studies demonstrated applications of AI in CSF segmentation and volumetric assessment, primarily for hydrocephalus diagnosis, mass effect evaluation, and stroke outcome prediction. Convolutional Neural Networks and Random Forests were the most frequent approaches. Reported segmentation accuracy was high, with Dice Similarity Coefficient values ranging from 0.75 to 0.95 and strong volumetric correlations (r up to 0.99) between AI-based and manual measurements. Conclusions: AI-assisted CSF segmentation from CT images shows promising accuracy and efficiency, with potential to enhance neurological diagnostics. Remaining challenges include dataset variability, inconsistent algorithm performance, and limited clinical validation. Future research should prioritize standardization of methods, larger and more diverse training datasets, and integration of AI tools into clinical workflows.