高场强MRI联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期的价值分析

张德生; 朱晓雷; 何剑; 郑屹峰; 吴晓; 储海瑞; 郭东闯

doi:10.16766/j.cnki.issn.1674-4152.002555

高场强MRI联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期的价值分析

doi: 10.16766/j.cnki.issn.1674-4152.002555

1.
湖州市中心医院，湖州师范学院附属中心医院放射科，浙江湖州 313000
2.
上海交通大学医学院附属瑞金医院放射科, 上海 200025

基金项目:

浙江省医药卫生科技计划项目 2020KY303

详细信息

通讯作者:
朱晓雷, E-mail: mayomedical1@163.com

中图分类号: R735.1 R445.2
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出版历程
- 收稿日期: 2021-03-25
- 网络出版日期: 2022-09-23

Value of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 in identifying T staging of oesophageal cancer

1.
Department of Radiology, Affiliated Central Hospital of Huzhou Normal University, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的分析高场强MRI联合血清细胞角蛋白19片段(CYFRA21-1)、糖类抗原72-4(CA72-4)、癌症抗原125(CA125)鉴别食管癌T分期的价值。方法选取2017年7月—2020年1月在上海交通大学医学院附属瑞金医院、湖州市中心医院拟行手术治疗的食管癌患者104例为研究对象，分析高场强MRI的图像质量，高场强MRI及其联合血清CYFRA21-1、CA72-4、CA125，采用Kappa一致性分析鉴别食管癌T分期的价值。结果高场强MRI图片质量2分6例、3分16例、4分40例、5分42例；高场强MRI诊断食管癌T分期的准确率为92.30%(96/104)，高场强MRI联合血清CYFRA21-1、CA72-4、CA125诊断食管癌T分期的准确率为95.19%(99/104)，与单一MRI诊断食管癌T分期的准确率差异有统计学意义(P＜0.05)；但诊断T2分期的特异度、准确率、阳性预测值，诊断T3分期的敏感度、特异度、准确率、阳性预测值、阴性预测值，诊断T4a分期的敏感度、准确率、阴性预测值均较单一高场强MRI诊断上升。结论单一高场强MRI或联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期均可获得良好效能，联合诊断效能略有提升。
- 食管癌 /
- T分期 /
- 高场强MRI /
- 细胞角蛋白21-1 /
- 糖类抗原72-4 /
- 癌症抗原125
Abstract: Objective To analyse the value of high-strength MRI combined with serum cytokeratin 19 fragment (CYFRA21-1), carbohydrate antigen 72-4 (CA72-4) and carbohydrate antigen 125 (CA125) in identifying T staging of oesophageal cancer. Methods From July 2017 to January 2020, 104 patients with esophageal cancer who were to be surgically treated in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Huzhou Central Hospital were selected as research objects. The image quality of high-field-intensity MRI and the value of high-field-intensity MRI combined with serum CYFRA21-1, CA72-4, CA125 were analysed. Kappa consistency analysis was used in identifying T staging of oesophageal cancer. Results There were 6 cases with high-strength MRI image quality scoring 2 points, 16 cases scoring 3 points, 40 cases scoring 4 points and 42 cases scoring 5 points. The accuracy of high-strength MRI for the diagnosis of T staging of oesophageal cancer was 92.30% (96/104). The accuracy rate of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 for the diagnosis of T staging of oesophageal cancer was 95.19% (99/104), which was significantly different from that of single MRI (P < 0.05). However, the specificity, accuracy, positive predictive value for stage T2; sensitivity, specificity, accuracy, positive predictive value, negative predictive value for stage T3; and sensitivity, accuracy, negative predictive value for stage T4a of combined diagnosis were higher than those of single high-strength MRI. Conclusion Single high-strength MRI or its combination with serum CYFRA21-1, CA72-4 and CA125 can effectively identify the T staging of oesophageal cancer, and the efficiency of combined diagnosis is slightly improved.
- Oesophageal cancer /
- T staging /
- High-strength MRI /
- Cytokeratin 21-1 /
- Carbohydrate antigen 72-4 /
- Carbohydrate antigen 125

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表 1 高场强扫描序列及参数

Table 1. High field strength scanning sequence and parameters

参数	BLADE-TSE-T₂WI (膈肌导航)	DWI	radial-容积内插体部检查
层厚(mm)	3	3	3
TR(ms)	4 000~8 000	5 000	3.98
回波时间(ms)	97	55	1.91
脉冲重复激发次数	1		1
矩阵	256×256	128×128	288×288
视野(mm)	240×240	300×300	300×300
扫描时间(s)	360~600	157	309
b值(s/mm²)		0、700

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表 2 高场强MRI联合血清CYFRA21-1、CA72-4、CA125诊断方法

Table 2. High-field MRI combined with serum CYFRA21-1, CA72-4, CA125 diagnostic methods

T分期	高场强MRI	血清肿瘤标志物
T1	阳性	CYFRA21-1阴性、CA72-4阴性、CA125阴性，至少满足任意1项
T2	阳性	CYFRA21-1阳性、CA72-4阳性、CA125阳性，至少满足任意1项
T3	阳性	CYFRA21-1阳性、CA72-4阳性、CA125阳性，至少满足任意2项
T4a	阳性	CYFRA21-1阳性、CA72-4阳性、CA125阳性，同时满足3项

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表 3 高场强MRI诊断T分期结果与术后病理对照(例)

Table 3. The results of high-field MRI diagnosis of T staging and postoperative pathological comparison (cases)

T分期	高场强MRI诊断T分期				合计
T分期	T1	T2	T3	T4a	合计
T1	22	1	0	0	23
T2	0	26	0	0	26
T3	0	4	42	0	46
T4a	0	0	3	6	9
合计	22	31	45	6	104

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表 4 高场强MRI对食管癌T分期的诊断价值(%)

Table 4. Diagnostic value of high-field MRI for T staging of esophageal cancer (%)

T分期	敏感度	特异度	准确率	阳性预测值	阴性预测值
T1	100.00	100.00	100.00	100.00	100.00
T2	100.00	93.58	95.19	83.87	100.00
T3	91.30	94.82	93.26	93.33	93.20
T4a	66.67	100.00	97.11	100.00	96.93

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表 5 不同T分期的食管癌患者血清CYFRA21-1、CA72-4、CA125阳性情况[例(%)]

Table 5. Positive status of serum CYFRA21-1, CA72-4 and CA125 in patients with esophageal cancer in different T stages [cases (%)]

T分期	例数	CYFRA21-1阳性	CA72-4阳性	CA125阳性
T1	23	4(17.39)	4(17.39)	1(4.35)
T2	26	6(23.08)	7(26.92)	4(15.38)
T3	46	28(60.87)	31(67.39)	17(36.96)
T4a	9	6(66.67)	7(77.78)	7(77.78)
χ²值		18.471	23.396	21.380
P值		＜0.001	＜0.001	＜0.001

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表 6 联合诊断食管癌T分期与术后病理对照(例)

Table 6. Combined diagnosis of esophageal cancer T staging and postoperative pathological comparison (cases)

T分期	高场强MRI联合血清CYFRA21-1、CA72-4、CA125诊断T分期				合计
T分期	T1	T2	T3	T4a	合计
T1	22	1	0	0	23
T2	0	26	0	0	26
T3	0	2	44	0	46
T4a	0	0	2	7	9
合计	22	29	46	7	104

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表 7 联合诊断食管癌T分期的诊断价值(%)

Table 7. Diagnostic value of T staging for combined diagnosis of esophageal cancer (%)

T分期	敏感度	特异度	准确率	阳性预测值	阴性预测值
T1	100.00	100.00	100.00	100.00	100.00
T2	100.00	96.15	97.11	89.65	100.00
T3	95.65	96.55	96.15	95.65	96.55
T4a	77.78	100.00	98.07	100.00	97.93

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