IVIM-DWI参数联合血清肿瘤标志物检测在宫颈癌诊断及分化程度评估中的应用价值

Application Value of IVIM-DWI Parameters Combined with Serum Tumor Markers in the Diagnosis and Differentiation Assessment of Cervical Cancer

目的分析体素内不相干运动扩散加权成像(IVIM-DWI)参数联合血清肿瘤标志物检测在宫颈癌诊断及分化程度评估中的应用价值。方法选取本院94例宫颈癌患者(宫颈癌组)及同期50例体检健康者(对照组),依据病理学检查,将宫颈癌患者分为低分化组、中分化组与高分化组,均行IVIM-DWI检查,比较宫颈癌组与对照组、不同分化程度组IVIM-DWI参数[伪扩散系数(D*)、纯扩散系数(D)、灌注分数(f)以及表观扩散系数(ADC)]、血清肿瘤标志物[糖类抗原-125(CA125)、糖类抗原-199(CA199)、癌胚抗原(CEA)与鳞状上皮细胞癌抗原(SCCA)],采用绘制受试者工作特征(ROC)曲线分析IVIM-DWI参数联合血清肿瘤标志物对宫颈癌、高分化的诊断价值。结果宫颈癌组D、f、ADC显著小于对照组(P<0.05);宫颈癌组血清CA125、CA199、CEA及SCCA水平显著高于对照组(P<0.05);不同分化程度组D*、f比较无显著差异(P>0.05);D、ADC为:低分化组<中分化组<高分化组(P<0.05);CA125、CA199、CEA、SCCA水平为:低分化组>中分化组>高分化组(P<0.05);D、f、ADC、CA125、CA199、CEA、SCCA单独及联合诊断宫颈癌AUC依次为0.605、0.788、0.788、0.870、0.921、0.898、0.843及0.992,联合诊断敏感度为97.93%,特异度为94.02%;D、ADC、CA125、CA199、CEA、SCCA单独及联合评估高分化AUC分别为0.734、0.818、0.661、0.838、0.923、0.790、0.965,联合评估敏感度为99.23%,特异度为81.38%。结论IVIM-DWI参数联合血清CA125、CA199、CEA、SCCA对宫颈癌具有较高诊断效能,且可为分化程度评估提供有效指导。

Objective To analyze the application value of intravoxel incoherent motion diffusion-weighted imaging(IVIM-DWI)parameters combined with serum tumor markers in the diagnosis and differentiation assessment of cervical cancer.Methods 94 patients with cervical cancer and 50 healthy individuals(control group)were selected as the subjects at the same time.According to pathological examination,the patients were divided into poor differentiation group,moderate differentiation group and high differentiation group.All patients were examined with IVIM-DWI.The IVIM-DWI parameters[pseudo diffusion coefficient(D*),pure diffusion coefficient(D),perfusion fraction(f)and apparent diffusion coefficient(ADC)]and serum tumor markers[carbohydrate antigen-125(CA125),carbohydrate antigen-199(CA199),carcinoembryonic antigen(CEA)and squamous cell carcinoma antigen(SCCA)]were compared between the cervical cancer group and the control group,and between patients with different differentiation degrees.The value of IVIM-DWI parameters combined with serum tumor markers in the diagnosis of cervical cancer and high differentiation was analyzed using the receiver operating characteristic(ROC)curve.Results D,f and ADC values in the cervical cancer group were significantly lower than those in the control group(P<0.05).Serum levels of CA125,CA199,CEA and SCCA in the cervical cancer group were significantly higher than those in the control group(P<0.05).There was no significant difference in D*or f between patients with different differentiation degrees(P>0.05).D and ADC value increased in order from the poor differentiation group,the moderate differentiation group to the high differentiation group(P<0.05).The levels of CA125,CA199,CEA and SCCA decreased in order from the poor differentiation group,the moderate differentiation group to the high differentiation group(P<0.05).The AUC values of D,f,ADC,CA125,CA199,CEA,SCCA,and their combination for diagnosing cervical cancer were 0.605,0.788,0.788,0.870,0.921,0.898,0.843 and 0.992.The sensitivity and specificity of combined diagnosis were 97.93%and 94.02%.The AUC values of D,f,ADC,CA125,CA199,CEA,SCCA,and their combination for assessing high differentiation were 0.734,0.818,0.661,0.838,0.923,0.790 and 0.965.The sensitivity and specificity were 99.23%and 81.38%.Conclusion IVIM-DWI parameters combined with serum CA125,CA199,CEA and SCCA is of high value in the diagnosis of cervical cancer,and can provide effective guidance for assessing differentiation degree.