DWI-MRI联合HE4、SCC-Ag在卵巢良恶性肿瘤鉴别中的价值

DWI-MRI combined with HE4 and SCC-Ag in diagnosis of benign and malignant ovarian tumors

摘要:

目的 评估磁共振成像-弥散加权成像（MRI-DWI）联合人附睾蛋白4（HE4）、鳞状细胞癌抗原（SCC-Ag）在卵巢良恶性肿瘤鉴别中的价值。方法 选择2018年6月—2020年9月就诊于海南医学院第一附属医院的150例卵巢肿瘤患者作为研究对象。其中，腹部肿块26例，腹胀、腹部不适44例，阴道不规则流血25例，月经量增多31例，单纯腹部轻微疼痛24例。所有患者均接受MRI-DWI检查及血清HE4、SCC-Ag水平检测，以病理学检查结果为金标准，对比卵巢良恶性肿瘤患者的血清HE4、SCC-Ag水平及MRI-DWI相关指标，并评估MRI-DWI、HE4、SCC-Ag及三者联合鉴别卵巢良恶性肿瘤的诊断效能。结果 病理学检查结果显示，150例卵巢肿瘤患者中恶性肿瘤58例，良性肿瘤92例；恶性肿瘤患者血清HE4、SCC-A水平比良性肿瘤患者高（P <0.05）；恶性肿瘤病变最大径比良性肿瘤大，ADC值比良性肿瘤患者低，且以囊壁/分隔不均匀、囊实性≥ 30%、T₂信号不均匀为主（P <0.05）；将病理学诊断结果作为金标准，MRI-DWI鉴别卵巢良恶性肿瘤的敏感性为79.31%（95% CI：0.705，0.852），特异性为84.78%（95% CI：0.752，0.895），准确性为82.67%（95% CI：0.742，0.876）；SCC-A敏感性为77.59%（95% CI：0.684，0.826），特异性为81.52%（95% CI：0.726，0.862），准确性为80.00%（95% CI：0.714，0.885）；HE4敏感性为74.14%（95% CI：0.656，0.795），特异性为78.26%（95% CI：0.699，0.844），准确性为76.67%（95% CI：0.678，0.834）；联合检测的敏感性为87.93%（95% CI：0.826，0.925），特异性为94.57%（95% CI：0.899，0.986），准确性为92.00%（95% CI：0.887，0.964）。结论 卵巢恶性肿瘤患者的MRI-DWI影像学特点以T₂信号不均匀、ADC值低且存在囊壁/分隔不均匀、囊实性等为主，且联合检测血清HE4、SCC-Ag可提升卵巢肿瘤良恶性鉴别的诊断效能，为临床诊治提供参考。

Abstract:

Objective To evaluate the value of MRI-DWI combined with serum human epididymal protein 4 (HE4) and squamous cell carcinoma antibody (SCC-Ag) in the diagnosis of benign and malignant ovarian tumors.Methods From June 2018 to September 2020, 150 patients with ovarian tumor, 26 cases of abdominal mass, 49 cases of abdominal distension and discomfort, 25 cases of irregular vaginal bleeding, 31 cases of increased menstrual flow, 24 cases of simple abdominal mild pain were selected. All patients were examined by MRI-DWI and serum HE4 and SCC-Ag levels test. The serum HE4, SCC-Ag levels, and MRI-DWI related indexes in patients with benign or malignant ovarian tumors were compared. The diagnostic efficacy of MRI-DWI, HE4, SCC-Ag, and their combination in differentiating benign and malignant ovarian tumors was evaluated.Results The pathological examination results showed that among the 150 patients with ovarian tumors, 58 were malignant tumors and 92 were benign tumors; the serum HE4 and SCC-A levels of malignant tumor patients were higher than those of benign tumor patients (P < 0.05); the maximum diameter ratio of malignant tumor patients with benign tumors have a higher ADC value than those with benign tumors, and the main features are uneven cyst wall/separation, cystic solid ≥ 30%, and uneven T₂ signal (P < 0.05); the sensitivity, specificity, and accuracy of MRI-DWI were 79.31% (95% CI: 0.705, 0.852), 84.78% (95% CI: 0.752, 0.895), and 82.67% (95% CI: 0.742, 0.876), respectively; the sensitivity, specificity, and accuracy of SCC-A were 77.59% (95% CI: 0.684, 0.826), 81.52% (95% CI: 0.726, 0.862), and 80.00% (95% CI: 0.714, 0.885), respectively; the sensitivity, specificity and accuracy of HE4 were 74.14% (95% CI: 0.656, 0.795), 78.26% (95% CI: 0.699, 0.844), and 76.67% (95% CI: 0.678, 0.834), respectively; the combined sensitivity, specificity, and accuracy were 87.93% (95% CI: 0.826, 0.925), 94.57% (95% CI: 0.899, 0.986), and 92.00% (95% CI: 0.887, 0.964), respectively.Conclusions The MRI-DWI imaging characteristics of patients with ovarian malignant tumors are mainly based on uneven T₂ signal, low ADC value, uneven cyst wall/separation, cystic solidity, and the combined detection of serum HE4 and SCC-Ag can improve the diagnostic efficiency of tumor differentiation between benign and malignant ovarian tumors, and provides a reference for clinical diagnosis and treatment.