A Multicentre Comparative Analysis of Radiomics, Deep-learning, and Fusion Models for Predicting Postpartum Hemorrhage.

Rationale And Objective: This study compared the capabilities of two-dimensional (2D) and three-dimensional (3D) deep learning (DL), radiomics, and fusion models to predict postpartum hemorrhage (PPH), using sagittal T2-weighted MRI images.

Materials And Methods: This retrospective study successively included 581 pregnant women suspected of placenta accreta spectrum (PAS) disorders who underwent placental MRI assessment between May 2018 and June 2024 in two hospitals. Clinical information was collected, and MRI images were analyzed by two experienced radiologists. The study cohort was divided into training (hospital 1, n=470) and validation (hospital 2, n=160) sets. Radiomics features were extracted after image segmentation to develop the radiomics model, 2D and 3D DL models were developed, and two fusion strategies (early and late fusion) were used to construct the fusion models. ROC curves, AUC, sensitivity, specificity, calibration curves, and decision curve analysis were used to evaluate the models' performance.

Results: The late-fusion model (DLRad_LF) yielded the highest performance, with AUCs of 0.955 (95% CI: 0.935-0.974) and 0.898 (95% CI: 0.848-0.949) in the training and validation sets, respectively. In the validation set, the AUC of the 3D DL model was significantly larger than those of the radiomics (AUC=0.676, P<0.001) and 2D DL (AUC=0.752, P<0.001) models. Subgroup analysis found that placenta previa and PAS did not impact the models' performance significantly.

Conclusion: The DLRad_LF model could predict PPH reasonably accurately based on sagittal T2-weighted MRI images.