Prediction of adverse neonatal outcomes in pregnancy-induced hypertension using IVIM-DWI-based microstructure,...

Pregnancy-induced hypertension (PIH) is a common and serious pregnancy complication that threatens maternal safety and perinatal outcomes. We aimed to develop a nomogram model integrating intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) microstructure and microcirculation and multisequence MR texture features for predicting adverse outcomes in PIH.

This retrospective study enrolled 63 PIH patients (37 with, 26 without adverse neonatal outcomes). Texture features were extracted from T1-, T2-weighted, and IVIM-DWI images. IVIM-DWI placental parameters included one DWI-based virtual magnetic resonance elastography (vMRE) parameter and six IVIM-based diffusion and perfusion parameters. Three predictive models were constructed: model 1 (texture score [T-score]) utilized multisequence texture features, model 2 incorporated IVIM-DWI parameters and model 3 (a nomogram model) combined T-score and IVIM-DWI parameters. Model performances were assessed via receiver operating characteristic (ROC) curves, area under the curve (AUC), decision curve analysis (DCA), and calibration.

Texture analysis identified 12 features from three sequences for model 1, which demonstrated an AUC of 0.796. The placental shear modulus (μ_diff) from vMRE and perfusion fraction (f) from IVIM were identified as predictors of adverse neonatal outcomes in PIH patients; model 2 using these two parameters displayed an AUC of 0.785. Model 3, the nomogram model that included T-score, μ_diff, and f, exhibited enhanced predictive accuracy with an AUC of 0.844, sensitivity of 83.8%, and specificity of 73.1%.

The nomogram model constructed using placental IVIM-DWI-derived microstructural, microcirculatory, and multisequence texture features may facilitate predicting adverse neonatal outcomes in patients with PIH.