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Standard diffusion-weighted, diffusion kurtosis and intravoxel incoherent motion in differentiating invasive placentas

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To investigate the diagnostic value of monoexponential, biexponential, and diffusion kurtosis MR imaging (MRI) in distinguishing invasive placentas.

Methods

A total of 53 patients with invasive placentas and 47 patients with noninvasive placentas undergoing conventional diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) were retrospectively enrolled. The mean, minimum, and maximum parameters including the apparent diffusion coefficient (ADC) and exponential ADC (eADC) from standard DWI, diffusion kurtosis (MK), and diffusion coefficient (MD) from DKI and pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from IVIM were measured and compared from the volumetric analysis. Receiver operating characteristics (ROC) curve and logistic regression analyses were conducted to evaluate the diagnostic efficiency of different diffusion parameters for distinguishing invasive placentas.

Results

Comparisons between accreta lesions in patients with invasive placentas (AL) and lower 1/3 part of the placenta in patients with noninvasive placentas (LP) demonstrated that MD mean, D mean, and D* mean were significantly lower while ADC max and D max were significantly higher in invasive placentas (all p < 0.05). Multivariate analysis demonstrated that D mean, D max and D* mean differed significantly among all the studied parameters for invasive placentas. A combined use of these three parameters yielded an AUC of 0.86 with sensitivity, specificity, and accuracy of 84.91%, 76.60%, and 80%, respectively.

Conclusion

The combined use of different IVIM parameters is helpful in distinguishing invasive placentas.

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Data availability

The datasets generated during and analyzed during the current study are not publicly available due to PACS system regulated by Sichuan Provincial People’s Hospital, but are available from the corresponding author on reasonable request.

Abbreviations

DWI:

Diffusion-weighted imaging

IVIM:

Intravoxel incoherent motion

DKI:

Diffusion kurtosis imaging

ADC:

Apparent diffusion coefficient

eADC:

Exponential ADC

MK:

Diffusion kurtosis

MD:

Diffusion coefficient

ROC:

Receiver operating characteristics

AL:

Accreta lesions

LP:

Lower 1/3 part of the placenta

PAS:

Placenta accreta spectrum

FIGO:

International federation of gynaecology and obstetrics

ESUR:

The society of abdominal radiology (SAR) and the European society of urogenital Radiology

MRI:

Magnetic resonance imaging

CD:

Cesaerean delivery

AUC:

Area under the curve

GA:

Gestational age

EVT:

Extravillous trophoblast

MNGC:

Multinucleated trophoblast giant cells

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Funding

This research is supported by Sichuan province science and technology program (2021YJ0237).

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Authors and Affiliations

  1. Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Chengdu, 610072, China

    Tao Lu, Mou Li, Yishuang Wang, Hang Li & Mingpeng Wu

  2. School of Mechanical and Electrical Engineering, University of Electronic Science and Technology of China, 2006 Xiyuan Avenue, West Hi-tech Zone, Chengdu, 611731, China

    Guotai Wang

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  1. Tao Lu
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  4. Hang Li
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Contributions

TL: project development, manuscript writing, YW: data collection, ML: data collection, HL: data collection, MW: data collection, GW: manuscript writing. YD, CW, XL have been removed as authors. The new authors approved the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Guotai Wang.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Informed consent

Informed consent was obtained from all individual participants included in the study. This study was approved by the Institutional Review Board (IRB) of Sichuan Provincial People’s Hospital.

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Lu, T., Li, M., Wang, Y. et al. Standard diffusion-weighted, diffusion kurtosis and intravoxel incoherent motion in differentiating invasive placentas. Arch Gynecol Obstet 309, 503–514 (2024). https://doi.org/10.1007/s00404-023-06947-4

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