雌激素、肿瘤标志物联合DCE-MRI在宫颈癌诊断及临床分期中的应用

doi:10.11938/cjmr20243133

摘要/Abstract

摘要：

准确可靠的宫颈癌诊断是临床治疗和预后评估的关键. 针对现有的血清雌激素、肿瘤标志物单独评估其宫旁浸润、淋巴结转移等病变特征敏感性较低，本文提出一种联合磁共振多期动态增强成像（DCE-MRI）的诊断方法，首先对患者进行血清雌二醇（E2）、促卵泡生成素（FSH）、促黄体生成素（LH）、糖链抗原125（CA125）、糖链抗原19-9（CA19-9）及DCE-MRI检测，分析宫颈癌分期与血清E2、FSH、LH、CA125、CA19-9水平相关性；然后，以宫颈活检结果为金标准，分析DCE-MRI对宫颈癌深肌层浸润、淋巴结转移的诊断准确率；最后，以受试者工作特征曲线（ROC）分析血清E2、FSH、LH、CA125、CA19-9水平、DCE-MRI诊断及联合诊断方法对宫颈癌的诊断价值. 实验结果表明，联合诊断的曲线下面积（AUC）为0.908，这表明联合诊断方法可较好区分宫颈病变的良恶性，而基于DCE-MRI参数K^trans、K^ep也进一步丰富了特征信息，从而提高病灶的检出精度，为宫颈癌良恶性鉴别及其临床分期诊断提供了新方法.

关键词: 雌激素, 肿瘤标志物, 磁共振多期动态增强成像, 宫颈癌, 联合诊断

Abstract:

Accurate and reliable diagnosis of cervical cancer is crucial for effective clinical treatment and prognosis evaluation. Given the low sensitivity of existing serum estrogen and tumor markers in assessing lesion features like parauterine invasion and lymph node metastasis, this study proposes a diagnostic method integrating multi-phase dynamic enhanced magnetic resonance imaging (DCE-MRI). Firstly, serum estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), glycochain antigen 125 (CA125), glycochain antigen 19-9 (CA19-9) and DCE-MRI were detected to analyze the correlation between cervical cancer stage and serum levels of E2, FSH, LH, CA125 and CA19-9. Then, cervical biopsy results were used as the gold standard to analyze the diagnostic accuracy of DCE-MRI for cervical deep muscle invasion and lymph node metastasis. Finally, the serum levels of E2, FSH, LH, CA125, CA19-9, DCE-MRI diagnosis and combined diagnosis of cervical cancer were evaluated based on the receiver operating characteristic (ROC) curve. The experimental results showed that the AUC of combined diagnosis was 0.908, indicating that the combined diagnosis method effectively distinguished benign and malignant cervical lesions. Furthermore, DCE-MRI parameters K^trans and K^ep enriched the feature information, thereby improving the detection accuracy of lesions. This provides a novel approach for differentiating between benign and malignant cervical cancer and for determining its clinical stage.

Key words: estrogen, tumor markers, multi-phase dynamic enhanced magnetic resonance imaging, cervical cancer, combined diagnosis

中图分类号:

O482.53

左冰玉, 石丽莉, 宋佳, 赵阳, 李倩. 雌激素、肿瘤标志物联合DCE-MRI在宫颈癌诊断及临床分期中的应用[J]. 波谱学杂志, 2025, 42(2): 164-173.

ZUO Bingyu, SHI Lili, SONG Jia, ZHAO Yang, LI Qian. Application of Estrogen and Tumor Markers Combined with DCE-MRI in Diagnosis and Clinical Staging of Cervical Cancer[J]. Chinese Journal of Magnetic Resonance, 2025, 42(2): 164-173.

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组别	样本数（n）	年龄/岁	BMI/(kg/m²)	文化水平/例，括号内为百分占比
组别	样本数（n）	年龄/岁	BMI/(kg/m²)	初中及以下	初中’高中	大学及以上
对照组	63	47.95±3.26	25.61±0.88	12（19.05%）	28（44.44%）	23（36.51%）
研究组	87	48.04±2.11	25.82±1.01	18（20.69%）	37（42.53%）	32（36.78%）
P		0.838	0.187	0.804	0.815	0.973

分组	样本数（n）	E2/(pmol/L)	FSH/(mIU/mL)	LH/(mIU/mL)	CA125/(U/mL)	CA19-9/(U/mL)
对照组	63	58.15±6.46	14.26±2.89	8.08±2.41	16.15±6.46	19.58±6.72
研究组	87	280.09±13.55	200.48±10.63	211.52±10.75	206.28±10.47	212.47±9.63
t		120.400	135.400	147.400	127.600	136.700
P		<0.001	<0.001	<0.001	<0.001	<0.001

分组	样本数（n）	E2/（pmol/L）	FSH/（mIU/mL）	LH/（mIU/mL）	CA125/（U/mL）	CA19-9/（U/mL）
I期宫颈癌	25	268.88±2.15	191.72±1.87	201.09±0.25	195.92±0.08	205.02±2.18
Ⅱ期宫颈癌	24	278.39±2.83^*	197.44±2.65^*	209.99±2.32^*	205.98±2.69^*	211.28±2.47^*
Ⅲ期宫颈癌	19	289.87±3.35^*#	207.49±3.61^*#	219.08±3.21^*#	212.99±3.34^*#	218.34±3.62^*#
Ⅳ期宫颈癌	19	287.16±5.94^*#	208.82±2.19^*#	219.56±0.16^*#	213.52±3.23^*#	217.91±4.19^*#
F		143.800	214.700	467.900	507.200	90.540
P		<0.001	<0.001	<0.001	<0.001	<0.001

分组	样本（n）	K^trans/(min^-1)	K^ep/(min^-1)	V^e
I期宫颈癌	25	0.13±0.04	0.35±0.13	0.23±0.05
Ⅱ期宫颈癌	24	0.19±0.08^*	0.46±0.26^*	0.25±0.04
Ⅲ期宫颈癌	19	0.25±0.11^*#	0.59±0.17^*#	0.24±0.06
Ⅳ期宫颈癌	19	0.31±0.15^*#▲	0.87±0.21^*#▲	0.26±0.07
F		13.330	26.780	1.210
P		<0.001	0.002	0.311

宫颈活检	深肌层浸润		总计	淋巴结转移		总计
宫颈活检	阳性	阴性	总计	阳性	阴性	总计
阳性	72（82.76%）	10（11.49%）	82（94.25%）	73（83.91%）	10（11.49%）	83（95.40%）
阴性	4（4.60%）	1（1.15%）	5（5.75%）	3（3.45%）	1（1.15%）	4（4.60%）
总计	76（87.36%）	11（12.64%）	87（100.00%）	76（87.36%）	11（12.64%）	87（100.00%）