The relevance of placenta MRI diffusion-derived vessels density and morphological features in diagnosing placenta accreta spectrum
Abstract Objectives MRI morphological features are postulated to represent PAS (placenta accreta spectrum), while diffusion-derived vessel density (DDVD) computed from a simple diffusion MRI protocol is a new imaging biomarker representing perfusion. This study aims to explore the relevance of DDVD...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
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| Series: | BMC Medical Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12880-025-01735-9 |
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| Summary: | Abstract Objectives MRI morphological features are postulated to represent PAS (placenta accreta spectrum), while diffusion-derived vessel density (DDVD) computed from a simple diffusion MRI protocol is a new imaging biomarker representing perfusion. This study aims to explore the relevance of DDVD and MRI morphological features in diagnosing PAS. Methods We enrolled 86 patients with PAS and 40 pregnant women without PAS. Each case underwent intravoxel incoherent motion (IVIM) MRI sequence with 11 b-values. DDVD was the signal difference between b = 0 and b = 50 s/mm2 images. DDVDr of the placenta or the placental-myometrial interface was calculated as: [lower 1/3 placenta DDVD]/ [upper 2/3 placenta DDVD], respectively. Differences of DDVDr in non-PAS pregnancies and in mild or severe PAS patients were explored using Kruskal-Wallis H-test. χ2 test was used to assess the predictive ability of MRI morphological features in diagnosing all PAS and severe PAS. Receiver operating characteristics (ROC) analysis was used to estimate the discriminative ability of DDVDr and MRI morphological features for all PAS and severe PAS. Results DDVDr(placenta) and DDVDr(interface) were significantly higher in patients with severe PAS (median, 1.194 and 1.230) than those in non-PAS (1.024 and 1.016, both p < 0.001). T2 dark bands and abnormal intraplacental vascularity were identified as predictors for all-inclusive PAS and severe PAS. DDVDr(interface) was significantly higher in patients manifested with T2 dark bands and abnormal intraplacental vascularity (median, 1.242 vs. 1.116, 1.230 vs. 1.126 p < 0.05). When DDVDr(interface) and the MRI morphological features were combined for predicting all-inclusive PAS and severe PAS, the AUC reached 0.894 and 0.916, respectively. Conclusion The combination of placenta MRI diffusion-derived vessels density and qualitative can be used for the accurate prediction of PAS. |
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| ISSN: | 1471-2342 |