多模态影像及血清学特征对Ⅱ型上皮性卵巢癌的诊断价值研究

The diagnostic value of multimodal imaging and serological features for type II epithelial ovarian cancer

目的 探讨多模态影像定量参数及CA125等血清学特征在Ⅱ型上皮性卵巢癌(EOC)诊断中的价值。方法 选取上皮性卵巢癌患者的术前临床、影像学资料,按术后病理诊断将患者96例分为两种类型,I型41例,II型55例。所有患者术前均行腹盆腔CT增强检查及MRI检查,分别测量记录病灶实性成分平均ADC值、CT值(平扫、动脉期、静脉期、延迟期),计算CT值差、CT强化率,记录肿瘤标志物CA125、HE4,将ADC值、CT值、CT值差、CT强化率、CA125及HE4分别进行单因素及多因素相关性分析,并绘制ROC曲线用于评价II型上皮性卵巢癌诊断性能。结果 单因素分析有统计学意义的指标(CA125、HE4、年龄、静脉期CT强化率、延迟期CT值差、ADC值)纳入多因素回归模型中,得出ADC值(OR:1.49,95%CI 0.99~2.00),CA125(OR:1.10,95%CI 1.00~1.15)及HE4(OR:1.20,95%CI 0.99~1.26)是Ⅱ型EOC诊断的独立影响因素;CA125、HE4、ADC及三者联合诊断效能曲线下面积(AUC)分别为0.72、0.75、0.85、0.88;ADC截断值为1.005×10^(-3)mm^(2)/s,CA125截断值为381 U/ml,HE4截断值196 Pmol/l时,诊断II型上皮性卵巢癌的敏感度、特异度分别为85.7%、74.9%、78.6%,61.5%,66.7%、82.6%,三者联合诊断II型上皮性卵巢癌的敏感度、特异度为81.5%、83.1%。结论 基于ADC值联合CA125、HE4肿瘤标志物建立的Logistic模型能有效地诊断Ⅱ型上皮性卵巢癌。

Objective To investigate the value of quantitative multimodal imaging parameters and serological features such as CA125 in the diagnosis of type II epithelial ovarian cancer.Methods The preoperative clinical and imaging data of patients with epithelial ovarian cancer in our hospital were retrospectively analyzed and the patients were divided into two groups accord-ing to the type of postoperative pathology:type II(55 patients,age 58±6 years)and type I(41 patients,age 51±4 years).All patients underwent preoperative CT-enhanced abdominopelvic examination and MR examination,and the mean ADC value and CT value of the solid component of the lesion(plain,arterial,venous and delayed phase)were measured and recorded respec-tively,and the CT value difference and CT enhancement rate were calculated,and the tumor markers,i.e.,CA125 and HE4 were recorded,and the ADC value,CT value,CT value difference,CT enhancement rate,CA125 and HE4 were analyzed for univariate and multifactorial correlations,and ROC curves were drawn to evaluate the diagnostic performance of type II epithelial ovarian cancer.Results Univariate analysis of statistically significant indicators,including CA125,HE4,age,venous phase CT enhancement rate,delayed phase CT value difference,and ADC value,were included in a multifactorial regression model,the ADC value(OR:1.49,95%CI:0.99 to 2.00),CA125(OR:1.10,95%CI:1.00 to 1.15)and HE4(OR:1.202,95%CI:0.999-1.206)were independent influences on the diagnosis of type II EOC;the area under the diagnostic effectiveness curve(AUC)of CA125,HE4,ADC and the combination of the three was 0.72,0.75,0.85 and 0.88,respectively;the cut-off value of ADC value was 1.005×10^(-3) mm^(2)/s.The sensitivity and specificity for the diagnosis of type II epithelial ovarian cancer were 85.7%,74.9%,78.6%,61.5%,66.7%and 82.6%when the cut-off value of ADC value was 1.005×10^(-3) mm^(2)/s,the cut-off value of CA125 was 381 U/ml and the cut-off value of HE4 was 196 Pmol/l.The sensitivity and specificity for the diagnosis of type II epithelial ovarian cancer were 85.7%,74.9%,78.6%,61.5%,66.7%and 82.6%,respectively.The sensitivity and specificity of the three combinations were 81.5%and 83.1%for the diagnosis of type II epithelial ovarian cancer.Conclusions The logis-tic model established based on ADC value combined with serum CA125 and HE4 can effectively identify type II epithelial ovar-ian cancer.