Magnetic Resonance Imaging–Based Radiomics Nomogram to Predict Intraoperative Hemorrhage of Placenta Previa

Abstract

Background: Placenta previa (PP) is associated with intraoperative and postpartum hemorrhage, increased maternal morbidity and mortality. We aimed to develop a magnetic resonance imaging (MRI)-based nomogram to preoperative prediction of intraoperative hemorrhage (IPH) for PP. Methods: A total of 125 PP pregnant women were divided into a training set (n = 80) and a validation set (n = 45). A MRI-based model was built for the classification of patients into IPH and non-IPH groups in a training set and a validation set. Multivariate nomograms were built according to radiomics features. Receiver operating characteristic (ROC) curve was used to assess the model. Predictive accuracy of nomogram were assessed by calibration plots and decision curve analysis. Results: In multivariate analysis, placenta position, placenta thickness, cervical blood sinus and placental signals in the cervix were signifcantly independent predictors for IPH (all p < 0.05). The MRI-based nomogram showed favorable discrimination between IPH and non-IPH groups. The calibration curve showed good agreement between the estimated and the actual probability of IPH. Decision curve analysis also showed a high clinical benefit across a wide range of probability thresholds. Area under the ROC curve (AUC) was 0.918 ( 95% CI, 0.857-0.979 ) in the training set and 0.866 ( 95% CI, 0.748-0.985 ) in the validation set by the combination of four MRI features. Conclusions: The MRI-based nomograms might be a useful tool for the preoperative prediction of IPH outcomes for PP. Our study enables obstetricians to perform adequate preoperative evaluation to reduce blood loss and caesarean hysterectomy.