T2WI、DWI序列联合血清CA125在子宫肉瘤与非典型子宫肌瘤鉴别诊断中的应用

Application of T2WI,DWI sequence combined with serum CA125 in the differential diagnosis of uterine sarcoma and atypical leiomyoma

目的探讨T2WI、扩散加权成像(diffusion weighted imaging,DWI)和平均表观扩散系数(mean apparent diffusion coefficient,mADC)联合癌抗原125(cancer antigen 125,CA125)在子宫肉瘤和非典型子宫肌瘤鉴别诊断中的应用价值。材料与方法回顾性分析2011年1月至2023年2月我院经病理证实的子宫肉瘤59例和非典型子宫肌瘤118例患者的相关资料。收集患者的T2WI、DWI序列的影像特征(包括信号强度、肿瘤最大径、mADC值)和临床相关信息(包括年龄、临床症状、绝经状态和血清CA125)。用Mann-Whitney U检验和卡方检验进行单因素分析,随后采用逻辑回归构建基于T2WI、DWI序列和血清CA125单独及联合应用的模型,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估预测模型的性能,计算模型的曲线下面积(area under the curve,AUC)、敏感度和特异度。结果子宫肉瘤组患者术前血清CA125显著高于非典型子宫肌瘤组(P=0.043)。在T2WI和DWI序列上,子宫肉瘤的实性成分相较于非典型肌瘤更多表现为高信号,且mADC值显著低于非典型子宫肌瘤(P均<0.001)。术前用于鉴别二者的血清CA125的最佳截断值为23.41 U/mL,mADC的最佳截断值为1.165×10^(-3)mm^(2)/s。T2WI、DWI、mADC值和血清CA125联合应用时,AUC为0.981(95%置信区间:0.966~0.996),敏感度为98.3%,特异度为92.4%(P<0.001)。结论T2WI、DWI序列联合血清CA125可作为鉴别子宫肉瘤和非典型子宫肌瘤的有效方法。

Objective:To explore the value of T2-weighted imaging(T2WI),diffusion weighted imaging(DWI)and mean apparent diffusion coefficient(mADC)combined with cancer antigen 125(CA125)in the differential diagnosis of uterine sarcoma and atypical leiomyoma.Materials and Methods:From January 2011 to February 2023,59 patients with uterine sarcoma and 118 patients with atypical leiomyomas confirmed by pathology in our hospital were retrospectively analyzed.The imaging features of T2WI and DWI(including signal intensity of T2WI and DWI,maximum tumor diameter,mADC value)and clinical relevant information(including age,clinical symptoms,menopausal status and serum CA125)were collected.Mann-Whitney U test and chi-square test were used for univariate analysis,and then logistic regression was used to construct models based on T2WI,DWI sequence and serum CA125 alone or in combination.The receiver operating characteristic(ROC)curve was used to evaluate the performance of the prediction model,and the area under the curve(AUC),sensitivity and specificity of the model were calculated.Results:The preoperative serum CA125 levels in the uterine sarcoma group were significantly higher than those in the atypical leiomyoma group(P=0.043).On T2WI and DWI sequences,the solid component of uterine sarcoma showed more hyperintensity than that of atypical leiomyoma,and the mADC value was significantly lower than that of atypical leiomyoma(all P<0.001).The optimal preoperative cut-off value for serum CA125 used to identify the two was 23.41 U/mL,and the optimal cut-off value for mADC was 1.165×10-3 mm2/s.The combination of T2WI,DWI,mADC values and serum CA125 resulted in an AUC of 0.981,a sensitivity of 98.3%and a specificity of 92.4%(P<0.001).Conclusions:T2WI and DWI sequences combined with serum CA125 can be used as an effective method to distinguish uterine sarcoma from atypical leiomyoma.