磁共振弥散加权成像联合糖类抗原125对卵巢交界性肿瘤与上皮性卵巢癌的鉴别诊断价值

Value of magnetic resonance diffusion weighted imaging combined with carbohydrate antigen 125 in differential diagnosis of borderline ovarian tumor and epithelial ovarian cancer

目的 探讨磁共振弥散加权成像(MRI-DWI)联合血清糖类抗原125(CA125)对卵巢交界性肿瘤与上皮性卵巢癌的鉴别诊断价值。方法 回顾性分析106例可疑卵巢交界性肿瘤或上皮性卵巢癌患者的临床资料,患者均接受MRI-DWI检查并检测血清CA125水平。根据病理学检查结果,将患者分为卵巢交界性肿瘤组59例与上皮性卵巢癌组47例。观察并比较2组患者MRI-DWI表现和CA125水平,绘制受试者工作特征(ROC)曲线,分析MRI-DWI、CA125单独和联合应用对卵巢交界性肿瘤与上皮性卵巢癌的鉴别效能。结果 卵巢交界性肿瘤组弥散加权成像(DWI)高信号占比、DWI信号强度依次为54.24%、(142.58±16.71),分别高于上皮性卵巢癌组的34.04%、(126.35±12.20),差异有统计学意义(P<0.05)。卵巢交界性肿瘤组b值为150、500、800、1 000 s/mm^(2)时的表观弥散系数(ADC)值依次为(2.05±0.39)、(1.85±0.35)、(1.75±0.42)、(1.61±0.32)×10^(-3)mm^(2)/s,分别高于上皮性卵巢癌组的(1.24±0.31)、(1.03±0.22)、(0.92±0.18)、(0.86±0.17)×10^(-3)mm^(2)/s,差异有统计学意义(P<0.05);卵巢交界性肿瘤组b值为800、1 000 s/mm^(2)时的R值依次为(1.58±0.23)、(2.15±0.33),分别高于上皮性卵巢癌组的(1.20±0.21)、(1.52±0.24),差异有统计学意义(P<0.05)。卵巢交界性肿瘤组CA125水平为(18.12±3.14) U/mL,低于上皮性卵巢癌组的(81.50±12.43) U/mL,差异有统计学意义(P<0.05)。b值为150、500、800、1 000 s/mm^(2)时的ADC值鉴别卵巢交界性肿瘤与上皮性卵巢癌的Cut-off值分别为1.71×10^(-3)、1.42×10^(-3)、1.31×10^(-3)、1.15×10^(-3)mm^(2)/s,b值为800、1 000 s/mm^(2)时的R值鉴别的Cut-off值分别为1.42、1.71, CA125鉴别的Cut-off值为40.50 U/mL;MRI-DWI联合CA125鉴别卵巢交界性肿瘤与上皮性卵巢癌的灵敏度和曲线下面积(AUC)依次为100.00%和0.907,分别高于、大于MRI-DWI、CA125单独鉴别。结论 相较于上皮性卵巢癌,卵巢交界性肿瘤DWI高信号占比、信号强度、不同b值时ADC值、b值为800与1 000 s/mm^(2)时R值、CA125水平均更高,而MRI-DWI联合CA125对两者具有理想的鉴别价值。

Objective To explore the differential value of magnetic resonance diffusion weighted imaging(MRI-DWI)combined with carbohydrate antigen 125(CA125)in differential diagnosis of borderline ovarian tumors and epithelial ovarian cancer.Methods The clinical data of 106 patients with suspected borderline ovarian tumor or epithelial ovarian cancer were analyzed retrospectively.All patients were examined with MRI-DWI,and CA125 level was detected.According to the results of pathological examination,they were divided into borderline ovarian tumors group(59 cases)and epithelial ovarian cancer group(47 cases).MRI-DWI and CA125 levels were compared between the two groups.Receiver operating characteristic(ROC)curve was drawn to analyze the identification efficiency of MRI-DWI and CA125 by MRI-DWI and CA125 alone or their combination for borderline ovarian tumors and epithelial ovarian cancer.Results The proportion of DWI high signal in the borderline ovarian tumors group was 54.24%,which was higher than 34.04%in the epithelial ovarian cancer group,and the DWI signal intensity was(142.58±16.71),which was higher than that of(126.35±12.20)in the epithelial ovarian cancer group(P<0.05).Apparent dispersion coefficient(ADC)at different b values of 150,500,800 and 1000×10^(-3) mm^(2)/s in the borderline ovarian tumors group were(2.05±0.39)×10^(-3) mm^(2)/s,(1.85±0.35)×10^(-3) mm^(2)/s,(1.75±0.42)×10^(-3) mm^(2)/s,(1.61±0.32)×10^(-3) mm^(2)/s,which were higher than those of(1.24±0.31)×10^(-3) mm^(2)/s,(1.03±0.22)×10^(-3) mm^(2)/s,(0.92±0.18)×10^(-3) mm^(2)/s,(0.86±0.17)×10^(-3) mm^(2)/s(P<0.05).R values at b values of 800 and 1000 s/mm^(2) were(1.58±0.23),(2.15±0.33)respectively,which were higher than(1.20±0.21),(1.52±0.24)in the epithelial ovarian cancer group(P<0.05).The CA125 level in the borderline ovarian tumors group was(18.12±3.14)U/mL,which was lower than that of(81.50±12.43)U/mL in the epithelial ovarian cancer group(P<0.05).The cut-off values of ADC with b values of 150,500,800 and 1000 s/mm^(2) were 1.71×10^(-3),1.42×10^(-3),1.31×10^(-3),1.15×10^(-3) mm^(2)/s for borderline ovarian cancer and epithelial ovarian cancer,respectively.The cut-off values of ADC with b values 800 and 1000 s/mm^(2) were 1.42 and 1.71 for borderline ovarian cancer and epithelial ovarian cancer,respectively.The sensitivity and area under curve(AUC)of MRI-DWI combined with CA125 were 100.00%and 0.907 respectively,which were higher than those of MRI-DWI or CA125 alone.Conclusion The proportion of high signal,signal intensity,ADC value at different b values,R value at b values of 800 and 1000 s/mm^(2) and CA125 level in ovarian borderline tumors are all higher than those in epithelial ovarian cancer,and the value of MRI-DWI combined with CA125 in distinguishing them is ideal.