Background: To develop an objective and quantitative measurement based on texture analysis of myometrium-derived T2WI to differentiate placenta accreta from increta.Methods: Participants with MRI and clinical or histopathological diagnosis of placenta increta were included. Texture analysis of T2WI was implemented on normal myometrium and placenta increta by MaZda software. Parameter selection and reduction was automatically done with Fisher discriminant method. Multivariate analysis was used

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... r the comparison of response variables between two groups. Profile analysis was used to compare the contours of multivariable average vectors. Two-step clustering was performed to evaluate the importance of parameters.Results: Multivariate analysis showed that nine second-order parameters between normal myometrium and placenta increta were statistically significant(P﹤0.05). The t-test showed that there were two parameters (Skew and Kurtosis) that had no statistical significance. Profile analysis showed that the profiles of seven parameters were neither parallel(P﹤0.05) nor coincident(P﹤0.05). The results of two-step cluster indicated that Mean, Percentile 90% and Percentile 99% were important (predictor importance﹥0.8).Conclusion: The study showed statistically significant differences for Mean, Percentile 90% and Percentile 99% between normal myometrium and placenta increta. Texture analysis of myometrium-derived T2WI may be a useful add-on to MRI in diagnosing placenta increta.Trial registration: Registration number: ChiCTR2000038604 and name of registry: Evaluation of diagnostic accuracy of MRI multi-parameter imaging combined with texture analysis for placenta accreta spectrum disorders (PAD).