Radiomics analysis of T2‐weighted images for differentiating invasive placentas in women at high risks

Purpose To develop and validate an MRI‐based radiomics model for differentiating invasive placentas in patients with high risks. Methods A total of 181 pregnant women suspected of placenta accreta spectrum (PAS) disorders and who underwent MRI for placenta evaluation were retrospectively enrolled. The data set was randomly divided into the training (n = 125; invasive = 63, noninvasive = 62) and test (n = 56; invasive = 28, noninvasive = 28) groups. Radiomics features were extracted from half‐Fourier acquisition single‐shot turbo spin echo (HASTE) and sagittal true fast imaging in steady‐state precession (TRUFISP) sequences independently and mainly selected based on their correlations with invasive placentas to construct two radiomics signatures including HASTE‐Radscore and TRUFISP‐Radscore. Then, the predictive performance of radiomic signatures, clinical features, radiographic features, and their combination were evaluated. The model with the best predictive performance was validated with its discrimination ability, calibration, and clinical usefulness. Results Five radiomics features from HASTE and three radiomics features from TRUFISP were retained, respectively, for predicting invasive placentas. The combination of radiomics signatures and clinical features including prior cesarean delivery, placenta previa, and radiographic feature, the placental thickness resulted in the best discrimination ability, with area under the curve of 0.898 (95% confidence interval [CI] 0.844–0.9522) and 0.858 (95% confidence interval 0.7514–0.9655) in the training and test cohort, respectively. The combined model showed a significantly better area under the curve performance and clinical usefulness than independent clinical or radiographic model according to DeLong test ( p < .05), net reclassification improvement and integrated discrimination improvement analysis (positive improvement) and decision curve analysis (higher net benefit). Conclusions The T 2 ‐weighted imaging MRI radiomics model could serve as a potential prenatal diagnosis tool for identifying invasive placentas in patients with high risks.