摘要
目的分析动态增强磁共振(DCE-MRI)半定量指标对卵巢癌鉴别诊断及评估国际妇产科联盟(FIGO)分期的临床意义。方法选择2021年1月至2023年1月西安市长安医院收治的卵巢肿瘤患者200例,根据病理检查结果分为良性组125例和恶性组75例,恶性组患者根据FIGO分期分为Ⅰ期组12例、Ⅱ期组34例、Ⅲ期组17和Ⅳ期组12例。所有患者病理检查前均行DCE-MRI检查,绘制时间-信号强度(TIC)曲线并比较TIC曲线类型,检测并比较各组对比剂达峰值时间(TTP)、最大线性上升斜率(MSI)及最大线性下降斜率(MSD);采用受试者工作特征(ROC)曲线评估DCE-MRI半定量指标诊断卵巢癌及预测FIGO分期的价值。结果恶性组TIC曲线流出型患者比例明显高于良性组,而流入型患者比例明显低于良性组,差异均有统计学意义(P<0.05)。恶性组患者MSI、MSD明显高于良性组,TTP明显低于良性组,差异均有统计学意义(P<0.05)。ROC曲线结果显示,TTP、MSI、MSD诊断卵巢癌的曲线下面积(AUC)分别为0.765(95%CI:0.700~0.829)、0.802(95%CI:0.734~0.870)、0.731(95%CI:0.645~0.817),三者联合诊断卵巢癌的AUC为0.906(95%CI:0.860~0.953),灵敏度和特异度分别为82.70%、89.60%。Ⅰ期组患者MSI、MSD<Ⅱ期组<Ⅲ期组<Ⅳ期组(P<0.05),Ⅰ期组患者TTP>Ⅱ期组>Ⅲ期组>Ⅳ期组(P<0.05)。ROC曲线结果显示,TTP、MSI、MSD预测卵巢癌晚期的AUC分别为0.825(95%CI:0.756~0.894)、0.716(95%CI:0.642~0.791)、0.715(95%CI:0.631~0.799),三者联合预测卵巢癌晚期的AUC为0.892(95%CI:0.842~0.941),灵敏度和特异度分别为85.30%、87.20%。结论DCE-MRI半定量指标可有效评估卵巢病变血流动力学变化,卵巢癌患者TIC曲线多为流出型、平台型,TTP减少,MSI、MSD升高,且半定量指标变化与FIGO分期有关,故DCE-MRI检查在鉴别卵巢肿瘤性质及预测分期方面具有一定价值。
Objective To analyze the clinical significance of semi-quantitative indexes of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the differential diagnosis of ovarian cancer and evaluating the staging of the International Federation of Obstetrics and Gynecology(FIGO).Methods A total of 200 patients with ovarian tumors admitted to Chang′an Hospital from January 2021 to January 2023 were selected and divided into benign group(125 cases)and malignant group(75 cases)based on pathological examination.Patients in the malignant group were subdivided into stage I group(12 cases),stageⅡgroup(34 cases),stageⅢgroup(17 cases)and stageⅣgroup(12 cases)based on FIGO staging.DCE-MRI examinations were performed before pathological examination,and time-signal intensity(TIC)curves were established to compare the types of TIC curves,and the time to peak(TTP),maximum linear increase slope(MSI)and maximum linear decrease slope(MSD)in each group were detected and compared.The receiver operating characteristic(ROC)curves were employed to evaluate the value of semi-quantitative indicators of DCE-MRI in diagnosing ovarian cancer and predicting FIGO staging.Results The percentage of patients with outflow type of TIC curve in the malignant group was significantly higher than that in the benign group,while the proportion of patiens with inflow type of TIC curve was significantly lower than that in the benign group,the differences had statistical significance(P<0.05).The levels of MSI and MSD in the malignant group were significantly higher than those in the benign group,while the level of TTP was significantly lower than that in the benign group,the difference were statistically significant(P<0.05).The ROC curves showed that the area under the curve(AUC)of TTP,MSI,and MSD in diagnosing ovarian cancer were 0.765(95%CI:0.700-0.829),0.802(95%CI:0.734-0.870),and 0.731(95%CI:0.645-0.817),respectively,and the AUC of the combined of the above indexes in diagnosing ovarian cancer was 0.906(95%CI:0.860-0.953)with the sensitivity of 82.70%and specificity of 89.60%,respectively.The level of MSI and MSD gradually increased and the levels of TTP gradually decreased in patients in the stageⅠ,Ⅰ,ⅢandⅣgroups,and the differences were statistically significant(P<0.05).The ROC curves showed that the AUC predicted by TTP,MSI and MSD for advanced ovarian cancer were 0.825(95%CI:0.756-0.894),0.716(95%CI:0.642-0.791)and 0.715(95%CI:0.631-0.799),respectively.The combined detection of TTP,MSI,and MSD for advanced ovarian cancer was 0.892(95%CI:0.842-0.941),with sensitivity of 85.30%and specificity of 87.20%.Conclusion The semi-quantitative indicators of DCE-MRI can effectively evaluate the hemodynamic changes of ovarian lesions.The TIC curves of patients with ovarian cancer are mostly outflow or plateau type,with low expression of TTP levels and high expression of MSI and MSD,and the changes in semi-quantitative indexes are closely related to FIGO staging.DCE-MRI examination has certain value in distinguishing the nature of ovarian tumors and predicting staging.
作者
党永平
张涵
米文静
DANG Yongping;ZHANG Han;MI Wenjing(Imaging Department,Chang′an Hospital of Xi′an,Xi′an,Shaanxi 710121,China)
出处
《检验医学与临床》
CAS
2023年第21期3175-3179,共5页
Laboratory Medicine and Clinic
关键词
动态增强磁共振
半定量指标
卵巢癌
FIGO分期
dynamic enhanced magnetic resonance
semi-quantitative indexes
ovarian cancer
FIGO staging
