Rationale and objectives <p>Pregnancy-induced hypertension (PIH) is a common and serious pregnancy complication that threatens maternal safety and perinatal outcomes. We aimed to develop a nomogram model integrating intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) microstructure and microcirculation and multisequence MR texture features for predicting adverse outcomes in PIH.</p> Materials and methods <p>This retrospective study enrolled 63 PIH patients (37 with, 26 without adverse neonatal outcomes). Texture features were extracted from T1-, T2-weighted, and IVIM-DWI images. IVIM-DWI placental parameters included one DWI-based virtual magnetic resonance elastography (vMRE) parameter and six IVIM-based diffusion and perfusion parameters. Three predictive models were constructed: model 1 (texture score [T-score]) utilized multisequence texture features, model 2 incorporated IVIM-DWI parameters and model 3 (a nomogram model) combined T-score and IVIM-DWI parameters. Model performances were assessed via receiver operating characteristic (ROC) curves, area under the curve (AUC), decision curve analysis (DCA), and calibration.</p> Results <p>Texture analysis identified 12 features from three sequences for model 1, which demonstrated an AUC of 0.796. The placental shear modulus (<i>μ</i>_diff) from vMRE and perfusion fraction (<i>f</i>) from IVIM were identified as predictors of adverse neonatal outcomes in PIH patients; model 2 using these two parameters displayed an AUC of 0.785. Model 3, the nomogram model that included T-score,<i> μ</i>_diff, and <i>f</i>, exhibited enhanced predictive accuracy with an AUC of 0.844, sensitivity of 83.8%, and specificity of 73.1%.</p> Conclusion <p>The nomogram model constructed using placental IVIM-DWI-derived microstructural, microcirculatory, and multisequence texture features may facilitate predicting adverse neonatal outcomes in patients with PIH.</p>