浙江中西医结合杂志

王佳辉.DCE-MRI联合CYFRA21-1、CEA、CA19-9水平在直肠癌患者术前分期中的诊断价值分析[J].浙江中西医结合杂志,2025,35(9):

DCE-MRI联合CYFRA21-1、CEA、CA19-9水平在直肠癌患者术前分期中的诊断价值分析

Diagnostic value of DCE-MRI combined with levels of CYFRA21-1, CEA and CA19-9 in preoperative staging of rectal cancer patients

投稿时间：2024-11-05 修订日期：2025-04-01

DOI：

中文关键词: 直肠癌磁共振动态对比增强 C角蛋白19片段抗原21-1 癌胚抗原糖类抗原19-9 诊断价值

英文关键词:Rectal cancer Magnetic resonance dynamic contrast enhancement C-keratin 19 fragment antigen 21-1 Carcinoembryonic antigen Carbohydrate antigen 19-9 Diagnostic value

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作者	单位	E-mail
王佳辉^*	浙江省立同德医院	wjh13588173439@163.com

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中文摘要:

【】目的分析磁共振动态对比增强(DCE-MRI)定量指标联合C角蛋白19片段抗原21-1(CYFRA21-1)、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)水平在直肠癌患者术前分期中的诊断价值分析。方法 2020年8月至2023年8月我院收治的直肠癌患者88例,行根治性手术前均进行DCE-MRI检查。不同T、N分期直肠癌患者DCE-MRI定量指标[对比剂容量转换常数(Ktrans)、对比剂回流速率常数(Kep)]及血清CYFRA21-1、CEA、CA19-9水平,绘制受试者工作特征(ROC)曲线分析Ktrans、Kep、血清CYFRA21-1、CEA、CA19-9水平单独及联合检测对直肠癌T、N分期的诊断价值。结果 T Ⅲ~Ⅳ期组Ktrans、Kep及血清CYFRA21-1、CEA、CA19-9水平高于T I~Ⅱ期组(P<0.05)。将T Ⅲ~Ⅳ期纳入阳性,T I~Ⅱ期纳入阴性,绘制ROC曲线分析Ktrans、Kep及血清CYFRA21-1、CEA、CA19-9水平对直肠癌患者T分期的诊断价值,曲线下面积(AUC)为0.692、0.756、0.738、0.784、0.790、0.940 ,敏感性为64.29%、67.86%、67.86%、71.43%、73.21%、89.29%,特异性为71.87%、75.00%、81.25%、84.37%、78.12%、87.50%,联合检测AUC均最高(Z=3.833、2.964、3.215、2.679、2.456,P<0.05)。N1期组Ktrans、Kep及血清CYFRA21-1、CEA、CA19-9水平高于N0期组(P<0.05)。将N1纳入阳性,N0纳入阴性,绘制ROC曲线分析Ktrans、Kep及血清CYFRA21-1、CEA、CA19-9水平对直肠癌患者N分期的诊断价值,AUC为0.821、0.718、0.819、0.758、0.771、0.929,敏感性为79.49%、66.67%、74.36%、64.10%、79.49%、87.18%,特异性为75.51%、77.55%、83.67%、79.59%、65.31%、89.80%,联合检测AUC均最高(Z=2.428、3.241、2.442、2.885、2.696,P<0.05)。结论 DCE-MRI定量指标Ktrans、Kep联合CYFRA21-1、CEA、CA19-9水平在直肠癌患者术前T、N分期中的诊断价值较高。

英文摘要:

Objective To analyze the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) quantitative index combined with C-keratin 19 fragment antigen 21-1 (CYFRA21-1), carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in preoperative staging of rectal cancer patients. Methods From August 2020 to August 2023, 88 patients with rectal cancer admitted to our hospital underwent DCE-MRI examination before radical surgery. DCE-MRI quantitative index[contrast agent volume conversion constant (Ktrans), contrast agent reflux rate constant (Kep)] and serum levels of CYFRA21-1, CEA and CA19-9 of rectal cancer patients with the different T and N stages, Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of Ktrans, Kep, serum levels of CYFRA21-1, CEA, CA19-9 alone and combined in T and N stages of rectal cancer. Results The levels of Ktrans, Kep and serum CYFRA21-1, CEA and CA19-9 in the T Ⅲ~Ⅳ groups were higher than those in the T I~Ⅱ groups (P<0.05). Stage T Ⅲ~Ⅳ was included as positive, stage T I~Ⅱ was included as negative, ROC curve was drawn to analyze the diagnostic value of Ktrans, Kep and serum levels of CYFRA21-1, CEA and CA19-9 in T stage of rectal cancer patients, the area under the curve (AUC) was 0.692, 0.756, 0.738, 0.784, 0.790, 0.940, and the sensitivity was 64.29%, 67.86%, 67.86%, 71.43%, 73.21%, 89.29%, the specificity was 71.87%, 75.00%, 81.25%, 84.37%, 78.12%, 87.50%, and the AUC was the highest in the combined test (Z=3.833, 2.964, 3.215, 2.679, 2.456, P<0.05). The levels of Ktrans, Kep and serum levels of CYFRA21-1, CEA and CA19-9 in the stage N1 group were higher than those in the stage N0 group (P<0.05). N1 was included as positive and N0 as negative. ROC curve was drawn to analyze the diagnostic value of Ktrans, Kep and serum levels of CYFRA21-1, CEA and CA19-9 in N stage of rectal cancer patients, with AUC values of 0.821, 0.718, 0.819, 0.758, 0.771 and 0.929. The sensitivity was 79.49%, 66.67%, 74.36%, 64.10%, 79.49%, 87.18%, and the specificity was 75.51%, 77.55%, 83.67%, 79.59%, 65.31%, 89.80%. AUC was the highest in the combined tests (Z=2.428, 3.241, 2.442, 2.885, 2.696, P<0.05). Conclusion DCE-MRI quantitative index detection of Ktrans and Kep parameters combined with CYFRA21-1, CEA and CA19-9 levels was of high diagnostic value in preoperative T and N stages of rectal cancer patients.

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