DCE-MRI参数结合CA199、CA125、HE4鉴别BOT与Ⅰ期EOC的可行性研究

李兴武; 叶国柳

doi:10.16766/j.cnki.issn.1674-4152.003158

DCE-MRI参数结合CA199、CA125、HE4鉴别BOT与Ⅰ期EOC的可行性研究

doi: 10.16766/j.cnki.issn.1674-4152.003158

李兴武¹,
叶国柳^2, ,

1.
阜阳市肿瘤医院肿瘤妇科，安徽阜阳 236000
2.
蚌埠医学院第一附属医院妇科，安徽蚌埠 233004

基金项目:

安徽省高校科研项目 2022AH051428

详细信息

通讯作者:
叶国柳，E-mail: 657406599@qq.com

中图分类号: R737.31 R445.2
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- 文章访问数: 140
- HTML全文浏览量: 40
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2023-03-31
- 网络出版日期: 2023-10-19

Feasibility study of DCE-MRI parameters combined with CA199, CA125, HE4 in differentiating BOT from stage Ⅰ EOC

LI Xingwu¹,
YE Guoliu^{2
, ,}

1.
Department of Oncology and Gynecology, Fuyang Cancer Hospital, Fuyang, Anhui 236000, China

摘要

摘要: 目的明确诊断卵巢交界性肿瘤(BOT)、Ⅰ期上皮性卵巢癌(EOC)，对临床选择治疗方式有关键意义。本研究以动态增强磁共振(DCE-MRI)参数结合糖类抗原199(CA199)、CA125、(HE4)人附睾蛋白4鉴别诊断BOT与Ⅰ期EOC，分析其临床应用的可行性。方法收集2018年1月—2022年4月阜阳市肿瘤医院收治BOT患者95例(BOT组)，Ⅰ期EOC患者62例(EOC组)。对比2组DCE-MRI征象、定量参数及CA199、CA125、HE4表达水平，并分析不同检查对BOT与Ⅰ期EOC的诊断效果。结果 2组常规形态学比较差异无统计学意义(均P＞0.05)；EOC组达峰时间(TTP)值低于BOT组，对比剂最大浓度(Cmax)、AUC、最大线性斜率(MS)值均高于BOT组(均P＜0.05)。EOC组CA125、HE4、CA199表达水平均高于BOT组(均P＜0.05)。ROC曲线结果显示：DCE-MRI参数(TTP、Cmax、AUC、MS)和CA199、CA125、HE4对BOT与Ⅰ期EOC鉴别曲线下面积(AUC)分别为0.789、0.682、0.799、0.786、0.792、0.789、0.816，联合诊断的AUC值为0.956，高于四者单独诊断(P＜0.05)，联合诊断灵敏度、特异度分别为97.60%、94.80%。结论 BOT与Ⅰ期EOC在DCE-MRI参数及CA199、CA125、HE4表达水平中存在差异，DCE-MRI联合血清学指标对两者鉴别诊断可行性高。
- 动态增强磁共振 /
- 血清因子 /
- 卵巢交界性肿瘤 /
- Ⅰ期上皮性卵巢癌
Abstract: Objective Diagnosis of borderline ovarian tumor (BOT) and stage Ⅰ epithelial ovarian cancer (EOC) is of key significance for clinical selection of treatment. In this study, dynamic enhanced MRI (DCE-MRI) parameters combined with glycoantigen 199 (CA199), CA125, and human epididymal protein 4 (HE4) were used to differentially diagnose BOT and stage Ⅰ EOC, and analyze the feasibility of the clinical application. Methods A total of 95 BOT patients admitted to Fuyang Cancer Hospital from January 2018 to April 2022 were collected as BOT group, and 62 stage Ⅰ EOC patients were collected as EOC group. The DCE-MRI signs, quantitative parameters, and expression levels of CA199, CA125, and HE4 were compared between the two groups, and the diagnostic effects of different examinations on BOT and stage Ⅰ EOC were analyzed. Results There was no difference in conventional morphology between the two groups (all P > 0.05). The time to peak (TTP) values of EOC group were lower than those of BOT group, while the contrast agent maximum concentration (Cmax), area under curve (AUC) and maximum linear slope (MS) values of EOC group were higher than those of BOT group (all P < 0.05). Expression levels of CA125, HE4 and CA199 in EOC group were higher than those in BOT group (all P < 0.05). ROC curve results show DCE-MRI parameters (TTP, Cmax, AUC, MS) combined with CA199, CA125, HE4 for BOT and Stage Ⅰ EOC were 0.789, 0.682, 0.799, 0.786, 0.792, 0.789, 0.816, respectively. The AUC value of combined diagnosis was 0.956, which was higher than that of the four patients diagnosed alone (P < 0.05). The sensitivity and specificity of combined diagnosis were 97.60% and 94.80%, respectively. Conclusion There are differences in DCE-MRI parameters and CA199, CA125, HE4 expression levels between BOT and stage Ⅰ EOC, and DCE-MRI combined with serological indicators is highly feasible for the differential diagnosis of the two.
- Dynamic contrast-enhanced magnetic resonance /
- Serum factors /
- Ovarian borderline tumors /
- Stage Ⅰ epithelial ovarian cancer

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图 1 DCE-MRI结合CA199、CA125、HE4对BOT与Ⅰ期EOC鉴别的ROC曲线

注：A为TTP、Cmax、AUC、MS对BOT与Ⅰ期EOC鉴别ROC曲线；B为CA199、CA125、HE4对BOT与Ⅰ期EOC鉴别ROC曲线；C为联合诊断对BOT与Ⅰ期EOC鉴别ROC曲线。

Figure 1. ROC curve of DCE-MRI combined with CA199, CA125 and HE4 for BOT and Stage Ⅰ EOC identification

下载: 全尺寸图片幻灯片

图 2 BOT组典型病例图像

注：A、B提示左侧附件区多房囊性占位(箭头)。

Figure 2. Typical case images of the BOT group

下载: 全尺寸图片幻灯片

图 3 EOC组典型病例图像

注：盆腔内双侧附件区囊实性包块(箭头)。

Figure 3. Images of typical cases in the EOC group

下载: 全尺寸图片幻灯片

表 1 2组卵巢肿瘤患者影像学征象比较[例(%)]

Table 1. Comparison of imaging findings of ovarian tumor patients in two groups[cases (%)]

组别	例数	肿瘤类型			强化程度			病灶部位		分隔数
组别	例数	囊性	实性	囊实性	轻	中	重	单侧	双侧	0~4	≥5
BOT组	95	44(46.31)	22(23.16)	29(30.53)	26(27.37)	40(42.10)	29(30.53)	81(85.26)	14(14.74)	33(34.74)	62(65.26)
EOC组	62	19(30.65)	14(22.58)	29(46.77)	15(24.19)	25(40.32)	22(35.48)	46(74.19)	16(25.81)	24(38.81)	38(61.29)
统计量		4.982^a			-0.656^b			2.297^a		0.256^a
P值		0.082			0.512			0.084		0.612
注：^a为χ²值，^b为Z值。

下载: 导出CSV

表 2 2组卵巢肿瘤患者DCE-MRI定量参数比较(x±s)

Table 2. Comparison of DCE-MRI quantitative parameters in two groups of ovarian tumor patients(x±s)

组别	例数	TTP (s)	Cmax (mmol/L)	AUC	MS
BOT组	95	3.81±0.36	0.14±0.05	0.52±0.10	0.20±0.02
EOC组	62	3.45±0.31	0.20±0.06	0.67±0.11	0.37±0.07
t值		6.462	6.785	8.829	22.347
P值		＜0.001	＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 3 2组卵巢肿瘤患者CA199、CA125、HE4表达水平比较(x±s)

Table 3. Comparison of expression levels of CA199, CA125 and HE4 in two groups of ovarian tumor patients(x±s)

组别	例数	CA199 (U/mL)	CA125 (U/mL)	HE4 (pmol/L)
BOT组	95	62.45±7.15	19.63±4.15	83.55±7.18
EOC组	62	88.79±9.47	315.27±14.60	167.15±10.33
t值		19.814	186.439	59.825
P值		＜0.001	＜0.001	＜0.001

下载: 导出CSV

表 4 联合诊断对BOT与Ⅰ期EOC的鉴别效果

Table 4. Effect of combined diagnosis in differentiating BOT from Stage Ⅰ EOC

项目	截断值	AUC	95% CI	灵敏度	特异度	P值
TTP	3.19	0.789	0.704~0.873	0.744	0.628	＜0.001
Cmax	0.19	0.682	0.581~0.782	0.636	0.669	＜0.001
AUC	0.63	0.799	0.754~0.906	0.726	0.652	＜0.001
MS	0.18	0.786	0.722~0.887	0.751	0.730	＜0.001
CA199	76.26	0.792	0.707~0.877	0.638	0.776	＜0.001
CA125	220.74	0.789	0.697~0.877	0.625	0.722	＜0.001
HE4	116.55	0.816	0.734~0.884	0.811	0.732	＜0.001
联合		0.956	0.925~0.986	0.976	0.948	＜0.001

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