The value of intravoxel incoherent motion imaging in diagnosing placenta accreta spectrum disorders and predicting massive intraoperative bleeding
10.3760/cma.j.cn112149-20241018-00637
- VernacularTitle:体素内不相干运动成像诊断胎盘植入谱系疾病及预测术中大量失血的价值
- Author:
Xiaohan ZHENG
1
;
Xin CHEN
;
Guangbin WANG
Author Information
1. 山东第一医科大学附属省立医院医学影像科，济南 250021
- Keywords:
Placenta accreta;
Magnetic resonance imaging;
Intravoxel incoherent motion
- From:
Chinese Journal of Radiology
2024;58(12):1417-1423
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of intravoxel incoherent motion (IVIM) imaging parameters for the diagnosis of placenta accreta spectrum disorders (PASDs) and the prediction of massive intraoperative blood loss.Methods:The pregnant women with suspected PASDs were prospectively collected in this case-control study at the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2022. The participants were scanned using the IVIM sequence and were divided into two groups, the PASDs group (69 cases) and the control group (37 cases), based on cesarean section and pathological findings. The PASDs group was further stratified into superficial implantation subgroup (29 cases) and deep implantation subgroup (40 cases) according to the depth of placental implantation, and into massive blood loss subgroup (48 cases) and non-massive blood loss subgroup (21 cases) based on intraoperative blood loss. The IVIM parameters, including the diffusion coefficient (D), pseudo-diffusion coefficient (D *), and perfusion fraction (f), were measured. The Mann-Whitney U test was employed to compare IVIM parameters between the two groups, while the Kruskal-Wallis test was assessed among the three groups, with post-hoc Bonferroni corrections for multiple comparisons. The receiver operating characteristic curves were utilized to assess the diagnostic efficacy of IVIM parameters for PASDs and their predictive value for massive intraoperative blood loss. Results:The f value in the PASDs group [0.330 (0.302, 0.361)] was significantly higher than that in the control group [0.287 (0.269, 0.318)] ( Z=-5.25, P<0.001), while the differences in D and D * values were not statistically significant (both P>0.05). The overall differences in D and f values among the control, superficial implantation subgroup, and deep implantation subgroup were statistically significant ( H=7.73, P=0.021; H=46.19, P<0.001), whereas the difference in D * values was not ( H=2.20, P=0.353). The deep implantation subgroup exhibited a higher D value than that in the control group ( P=0.029), and a higher f value than that in both the superficial implantation subgroup and the control group (both P<0.001). The area under the curve (AUC) of 0.910 (95% CI 0.847-0.973) for the f value in diagnosing PASDs, and an AUC of 0.870 (95% CI 0.789-0.951) for distinguishing superficial from deep placental implantation. The AUC for the D value in distinguishing normal from deep placental implantation was 0.670 (95% CI 0.544-0.796). The difference in f value between the massive blood loss subgroup and non-massive blood loss subgroup was statistically significant ( Z=-3.47, P<0.001), with an AUC of 0.851 (95% CI 0.764-0.938) for predicting massive intraoperative blood loss. Conclusions:The placenta in patients with PASDs exhibits hyperperfusion, and f values can be used to diagnose PASDs, evaluate deep placental implantation, and predict massive intraoperative blood loss.
