MR DWI及联合血清CA125对卵巢占位性病变定性诊断的价值

目的探讨MR扩散加权成像及联合血清CA125对卵巢占位性病变定性诊断的价值。方法利用西门子3.0T磁共振后处理工作站对病理证实的75例卵巢占位性病变囊实性部分ADC值进行测量,对卵巢良恶性占位性病变ADC值采用独立样本t检验进行比较并应用受试者工作特征曲线(ROC)确定其最佳诊断阈值;卵巢囊、实性占位性病变各组间比较采用单向方差分析;MRI及MRI+CA125两种方法分别与病理采用配对计数资料的2检验和Kappa检验进行分析。结果卵巢良、恶性占位性病变囊性部分ADC值比较,有统计学意义(P=0.000),ROC曲线下面积为0.915,最佳良恶性阈值为2711.6×10-3 mm2/s;卵巢良、恶性占位性病变实性部分ADC值比较,有统计学意义(P=0.001),ROC曲线下面积为0.858,最佳良恶性阈值为920.3×10-3 mm2/s;卵巢囊性占位性病变整体组间比较有统计学意义(P<0.05),组间多重比较,卵巢恶性肿瘤及卵巢子宫内膜异位症分别与其余各组间均有统计学意义(P<0.05);卵巢实性占位性病变整体组间比较有统计学意义(P<0.05),组间多重比较分析,卵巢恶性肿瘤与其余各组间均有统计学意义(P<0.05);MRI、MRI+CA125两种方法分别与病理吻合分析,MRI诊断卵巢良恶性占位性病变灵敏度为90.0%,特异度为82.2%,准确度为85.3%,约登指数为72.2%;MRI+CA125联合诊断卵巢良恶性占位性病变灵敏度为93.3%,特异度为86.7%,准确度为89.3%,约登指数为80.0%;检验吻合系数MRI+CA125(0.783)>MRI(0.703),表明MRI+CA125联合诊断与病理的吻合度更好。结论 MR扩散加权成像及联合血清CA125对卵巢占位性病变定性诊断具有重要的价值,可以提高卵巢占位性病变早期诊断及鉴别诊断水平。

The Value of MR diffusion-weighted imaging combined with serum CA125 in the qualitative diagnosis of ovarian occupying lesion

Objective To evaluate the diagnostic value of MR diffusion weighted imaging combined with serum CA125 in ovarian occupying lesion. Methods The ADC value in cystic and solid parts of 75 cases of pathology confirmed ovarian masses was measured through the Siemens 3.0T MRI post-processing workstation. We then compared the ADC value of the ovarian benign and malignant space-occupying lesions through Independent-Sample T Test, and determined the best diagnosis threshold using receiver-operating characteristic curve （ROC）. Ovarian cystic and solid lesions were analyzed with One-Way ANOVA. MRI and MRI＋CA125 was respectively paired with pathology, for Pair-Sample 2 Test and Kappa Test. Results There was a significant difference （ P =0. 000） between the ADC value comparison about cystic parts of ovarian benign and malignant space-occupying lesions, the area under the ROC curve for 0.915, the best diagnosis threshold for 2711.6 × 10-3 mm2/s; There also has a significant difference （ P = 0. 001） between the ADC value comparison about solid parts of ovarian benign and malignant space-occupying lesions, the area under the ROC curve for 0. 858, the best di agnosis threshold for 920.3 × 10-3 mm2/s ; The whole group of ovarian cystic space-occupying lesions compassion had a sta tistieal significance （ P 〈0.05）, and for multiple comparison between groups, ovarian malignant tumor and ovarian endometriosis respectively had a statistically significant （ P〈0.05） compared with rest groups;The whole group of ovarian solid space-occupying lesions compassion also had a statistical significance （ P 〈0.05）, and for multiple comparison between groups, ovarian malignant tumor also had a statistically significant （ P 〈0.05） compared with remain groups; MRI and MRI ＋ CA125 were respectively compared with the pathological diagnosis. In the MRI diagnosis, the sensitivity, specificity, accuracy and Youden index were 90.0%, 82.2%, 85.3% and 72.2%, respectively. In the MRIq-CA125 di- agnosis, the sensitivity, specificity, accuracy and Youden index were 93.3%, 86.7%, 89.3% and 80.0%, respectively. In the coefficient, MRI＋CA125（0. 783） ＋ MRI （0. 703）, showed that MRI ＋ CA125 was more close to pathological diagnosis hetween two ways. Conclusion MR diffusion weighted imaging combined with serum CA125 in qualitative diagnosis of ovarian space-occupying lesions has an important value , and can improve early diagnosis and differential diagnosis level.