多模态MRI联合肿瘤标志物(CA19-9、CA72-4、CEA、AFP)在直肠癌术前T分期及肠壁外脉管侵犯中的诊断价值  

The diagnostic value of multimodal MRI combined with tumor markers CA19-9,CA72-4,CEA,and AFP in preoperative T staging and EMVI of rectal cancer

作　　者：王婉婷 丹巴玉珍 WANG Wan-ting;DAN Ba-yu-zhen(Department of Radiology,the Third People′s Hospital of Chengdu City,Sichuan Province,Chengdu 610000,China)

机构地区：[1]四川省成都市第三人民医院放射科,四川成都610000

出　　处：《河北医科大学学报》2025年第2期214-219,共6页Journal of Hebei Medical University

基　　金：四川省重点研发项目(23ZDYF1462)。

摘　　要：目的探讨多模态磁共振成像(multimodal magnetic resonance imaging,MRI)联合肿瘤标志物[糖类抗原19-9(carbohydrate Antigen 19-9,CA19-9)、癌抗原72-4(cancer Antigen 72-4,CA72-4)、癌胚抗原(carcinoembryonic Antigen,CEA)、甲胎蛋白(alpha-fetoprotein,AFP)]在直肠癌术前T分期及肠壁外脉管侵犯(extramural vascular invasion,EMVI)中的诊断价值。方法四川省成都市第三人民医院接收的直肠癌患者136例,以术后病理分期作为金标准,所有患者均进行多模态MRI检查及CA19-9、CA72-4、CEA、AFP水平检测,根据病理诊断结果分为EMVI阳性组(58例)与EMVI阴性组(78例),比较2组MRI检查结果及CA19-9、CA72-4、CEA、AFP水平,采用受试者工作特征曲线(receiver operating characteristic,ROC)分析多模态MRI联合CA19-9、CA72-4、CEA、AFP在EMVI中的诊断效能。结果术前T分期结果显示,T1期12例,T2期22例,T3期68例,T4期34例,经多模态MRI诊断出T1期8例,T2期16例,T3期59例,T4期29例;T3~T4期的CA19-9(43.14±4.28)kU/L、CA72-4(12.88±2.69)kU/L、CEA(23.11±2.89)μg/L、AFP(21.25±2.64)μg/L水平高于T1-T2期(10.33±2.03)kU/L、(6.12±1.47)kU/L、(13.15±3.24)μg/L、(16.25±3.27)μg/L(P<0.05);EMVI阳性组Ktrans、Kep较EMVI阴性组高,ADC较EMVI阴性组低;EMVI阳性组的CA19-9(55.87±5.63)kU/L、CA72-4(14.92±3.12)kU/L、CEA(14.89±2.14)μg/L水平高于EMVI阴性组(9.42±2.01)kU/L、(7.21±1.54)kU/L、(7.84±1.56)μg/L(P<0.05);ROC结果显示,多模态MRI联合肿瘤标志物在EMVI中的诊断敏感度、特异度为93.1%、97.4%,ROC曲线下面积为0.975(95%CI:0.946~1.000),高于单项检测。结论多模态MRI联合CA19-9、CA72-4、CEA、AFP水平检测在EMVI的诊断中具有较高的敏感度和特异度,其诊断效能显著优于单项检测,为直肠癌的术前评估提供了更为准确的诊断依据。Objective To explore the diagnostic value of multimodal magnetic resonance imaging(MRI)combined with tumor markers[carbohydrate Antigen 19-9(CA19-9),cancer antigen 72-4(CA72-4),carcinoembryonic antigen(CEA),alpha-fetoprotein(AFP)]in the preoperative T staging and extramural venous invasion(EMVI)of rectal cancer.Methods A retrospective analysis was conducted on 136 patients with rectal cancer treated at the Third People′s Hospital of Chengdu City.Using postoperative pathological staging as the gold standard,all patients underwent multimodal MRI and levels of CA19-9,CA72-4,CEA,and AFP were detected.Based on results of pathological diagnosis,patients were divided into positive EMVI group(n=58)and negative EMVI group(n=78).MRI results and levels of CA19-9,CA72-4,CEA,and AFP in the two groups were compared,and the diagnostic efficacy of multimodal MRI combined with these tumor markers in preoperative T staging and EMVI was analyzed using receiver operating characteristic(ROC)curves.Results Preoperative T staging showed 12 patients in T1,22 in T2,68 in T3,and 34 in T4.By multimodal MRI,8 patients were diagnosed as T1,16 as T2,59 as T3,and 29 as T4.The levels of CA19-9(43.14±4.28)kU/L,CA72-4(12.88±2.69)kU/L,CEA(23.11±2.89)μg/L,and AFP(21.25±2.64)μg/L in T3-T4 were higher than those in T1-T2(10.33±2.03)kU/L,(6.12±1.47)kU/L,(13.15±3.24)μg/L,(16.25±3.27)μg/L(P<0.05).Positive EMVI group had higher Ktrans,Kep,and lower ADC compared with the negative EMVI group;The levels of CA19-9(55.87±5.63)kU/L,CA72-4(14.92±3.12)kU/L,and CEA(14.89±2.14)μg/L were higher than those in the negative EMVI group(9.42±2.01)kU/L,(7.21±1.54)kU/L,(7.84±1.56)μg/L(P<0.05).ROC analysis showed that multimodal MRI combined with tumor markers in EMVI diagnosis had a sensitivity of 93.1%and a specificity of 97.4%,with an area under the ROC curve(AUC)of 0.975(95%CI:0.946-1.000),which was higher than single-item detection.Conclusion Multimodal MRI combined with CA19-9,CA72-4,CEA,and AFP levels demonstrates high sensitivity and specifici

关 键 词：直肠肿瘤 磁共振成像 肿瘤标志物 

分 类 号：R735.37[医药卫生—肿瘤]