MRI of the Placenta Accreta Spectrum (PAS) Disorder: Radiomics Analysis Correlates With Surgical and Pathological Outcome
MRI of the Placenta Accreta Spectrum (PAS) Disorder: Radiomics Analysis Correlates With Surgical and Pathological Outcome
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DOI：
10.1002/jmri.26883
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发表时间：
2020-03-01
影响因子：
4.4
通讯作者：
Twickler, Diane M.
中科院分区：
文献类型：
--
作者：
Do, Quyen N.;Lewis, Matthew A.;Twickler, Diane M.
背景：胎盘植入谱（PAS）在有剖宫产史的妇女中越来越普遍。根据严重程度，患者管理可能涉及剖宫产子宫切除术。目的：研究纹理分析作为胎盘MRI中的放射组学在预测高危人群中需要剖宫产子宫切除术的PAS中的作用。研究类型：回顾性。人群：62名既往剖宫产的妇女因超声怀疑PAS而接受MRI检查。场强/序列：1.5T，T1 W、T2 W和弥散加权成像（DWI）。评估：两名评审员根据五个已建立的PAS变量独立评估MR图像。胎盘感兴趣区域（ROI）的T2 W，DWI，和表观扩散系数（ADC）地图上产生的基础上，在接近和远离以前的手术切口sites.Statistical测试：阅读协议进行了评估，由简单的kappa和患病率调整偏差调整kappa（PABAK）的定义。对主要结局（子宫切除术与未子宫切除术）进行了T检验和卡方分析。从三次MR采集中的每一次采集中，从手动绘制的胎盘ROI中提取从灰度共生矩阵计算的十三个Haralick纹理特征。单因素和多因素Logistic回归分析用于评估与剖宫产子宫切除术的相关性。结果：62例有PAS风险的妊娠中，40例需要剖宫产子宫切除术（65%），子宫切除术的需要与子宫切除术标本中PAS的病理学确认之间具有良好的相关性[Kappa = 0.82（0.62，1）]。读者的一致性为公平至中等。在三个采集组的13个Haralick变量中，比较靠近切口瘢痕的胎盘ROI与远离瘢痕的胎盘ROI，在39个参数中的22个参数中观察到显著差异（P < 0.05）。逐步选择算法表明，T2 W F-cm.sum.var、ADC F-cm.diff.entr和DWI F-cm.energy的组合给出了最高的留一法AUC为0.80（0.68，0.91）.数据结论：PAS严重程度的评估是主观的，并且依赖于放射科医师的专业知识。我们确定了胎盘磁共振图像上的纹理特征，在该地区的先前子宫疤痕，区分妊娠需要剖宫产子宫切除术的基础上，从那些没有PAS的临床怀疑，这表明这些客观的放射组学特征的预测能力。
Background: Placenta accreta spectrum (PAS) in women with previous cesarean delivery has become increasingly prevalent. Depending on the severity, patient management may involve cesarean hysterectomy.Purpose: To investigate textural analyses as the radiomics in MRI of the placenta in predicting the PAS requiring cesarean hysterectomy in a high-risk population.Study Type: Retrospective.Population: Sixty-two women with prior cesarean delivery referred for MRI because of sonographic suspicion for PAS.Field Strength/Sequence: 1.5T with T1W, T2W, and diffusion-weighted imaging (DWI).Assessment: Two reviewers independently evaluated MR images based on five established PAS variables. Placental regions of interest (ROIs) were generated on T2W, DWI, and an apparent diffusion coefficient (ADC) map, based on definitions of areas of placenta in proximity to and remote from previous surgical incision sites.Statistical Tests: Reader agreement was assessed by simple kappa and prevalence adjusted bias adjusted kappa (PABAK). T-tests and chi-square analyses between the primary outcome (hysterectomy vs. no hysterectomy) were performed. Thirteen Haralick texture features calculated from gray-level co-occurrence matrixes were extracted from manually drawn placental ROIs within each of three MR acquisitions. Univariate and multivariable logistic regression were used to assess the association with cesarean hysterectomy.Results: Of 62 pregnancies at risk for PAS, 40 required cesarean hysterectomy (65%), with excellent correlation between need for hysterectomy and pathology confirmation of PAS in the hysterectomy specimen [kappa = 0.82 (0.62, 1)]. Reader agreement was fair to moderate. Of the 13 Haralick variables within each of three acquisition groups, significant differences (P < 0.05) were seen in 22 of 39 parameters comparing placental ROIs in proximity to incision scar(s) to those ROIs remote from scar. A stepwise selection algorithm indicated that the combination of T2W F-cm.sum.var, ADC F-cm.diff.entr, and DWI F-cm.energy gave the highest leave-one-out-AUC of 0.80 (0.68, 0.91).Data Conclusion: Assessment of PAS severity is subjective and dependent on radiologist expertise. We identified textural features on placental MR images in the region of the prior uterine scar that differentiated pregnancies requiring cesarean hysterectomy based on clinical suspicion of PAS from those that did not, suggesting predictive capabilities of these objective radiomics features.