临床参数结合磁共振成像特征对术前区分子宫肉瘤和子宫肌瘤的价值

Value of Clinical Parameters Combined with Magnetic Resonance Imaging Features in Preoperative Differentiation of Uterine Sarcoma and Uterine Fibroid

目的探讨临床参数[糖类抗原125(CA125)、乳酸脱氢酶(LDH)]结合磁共振成像(MRI)特征对术前区分子宫肉瘤和子宫肌瘤的价值。方法选取2019年7月至2022年8月诊治的50例子宫肉瘤患者作为研究对象,并设立为观察组,同期选取110例子宫肌瘤患者作为对照组。对比CA125、LDH及MRI参数[达峰时间(TTP)、表观扩散系数(ADC)];采用logistic回归模型建立CA125、LDH联合MRI参数诊断子宫肉瘤的模型;采用受试者工作特征(ROC)曲线模型分析CA125、LDH、TTP、ADC及四项联合诊断子宫肉瘤的曲线下面积(AUC)、敏感度及特异度。结果观察组的TTP、ADC低于对照组,而CA125、LDH高于对照组(P<0.05)。观察组在T_(2)WI、DWI多表现为高信号,边缘模糊,内膜受累;对照组在T_(2)WI、DWI多表现为低信号,多见边缘规整,内膜基本无受累;两组T_(2)WI、DWI、边缘、内膜受累等影像特征比较,差异有统计学意义(P<0.05),在T 1WI信号强度、囊变坏死、出血等影像特征比较,差异无统计学意义(P>0.05)。ROC曲线分析显示,TTP、ADC、CA125、LDH及四项联合诊断子宫肉瘤的AUC分别为0.876、0.829、0.858、0.872、0.973。结论临床参数联合MRI参数鉴别诊断子宫肉瘤和子宫肌瘤具有较高的价值。

Objective To explore the value of clinical parameters[carbohydrate antigen 125(CA125),lactate dehydrogenase(LDH)]and magnetic resonance imaging(MRI)characteristics in distinguishing uterine sarcoma from uterine fibroid before operation.Methods A total of 50 patients with uterine sarcoma diagnosed and treated from July 2019 to August 2022 were selected as the study subjects and set up as the observation group.At the same time,110 patients with uterine fibroid were selected as the control group.CA125,LDH and MRI parameters[time to peak(TTP),apparent diffusion coefficient(ADC)]were compared.A model of CA125,LDH combined with MRI parameters for diagnosis of uterine sarcoma was established using logistic regression model.Area under the curve(AUC),sensitivity and specificity of CA125,LDH,TTP,ADC and four combined diagnosis of uterine sarcoma were analyzed by receiver operating characteristic(ROC)curve.Results The TTP and ADC of the observation group were lower than those of the control group,while CA125 and LDH were higher than those of the control group(P<0.05).In the observation group,T_(2)WI and DWI showed high signal intensity,blurred edge and intimal involvement.The control group showed irregular elevation on T_(2)WI and DWI,with regular edges and almost no involvement of the endometrium.There were differences in imaging features such as T_(2)WI,DWI,edge and endometrial involvement between the two groups(P<0.05),while there were no differences in imaging features such as T 1WI signal intensity,cystic necrosis and bleeding(P>0.05).The ROC curve analysis showed that the AUC values of TTP,ADC,CA125,LDH and the four combined diagnoses of uterine sarcoma were 0.876,0.829,0.858,0.872,0.973.Conclusion Clinical parameters combined with MRI parameters have high value in differential diagnosis of uterine sarcoma and uterine fibroid.