【摘要】 目的 探讨动态对比增强磁共振成像（DCE-MRI）、扩散加权成像（DWI）联合血清癌胚抗原（CEA）、糖类抗原（CA199）水平用于评估直肠癌淋巴结转移的价值，为术前评估直肠癌淋巴结转移提供参考依据。方法回顾性分析2019年4月至2024年8月在焦作市人民医院接受手术治疗并经过病理确诊的67例直肠癌患者的肿瘤标志物和影像学资料，以术后病理结果为依据，将患者分为两组，即淋巴结转移阳性组（24例）、淋巴结转移阴性组（43例）。所有患者术前均有CEA、CA199的肿瘤标志物信息，以及包含DCE-MRI、DWI扫描，并测量最大淋巴结短径、ADCmin值和K^trans。运用单因素及多因素Logistic回归分析以上变量是否为直肠癌淋巴结转移的危险因素，并通过ROC评估DCE-MRI、DWI参数和肿瘤标志物在直肠癌淋巴结转移诊断中的价值。结果淋巴结转移阳性组和淋巴结转移阴性组在K^trans、最大淋巴结短径、ADCmin值、血清CEA、CA199水平方面比较，差异有统计学意义（P<0.05）。将以上4个潜在危险因素进行多因素Logistic分析，结果显示K^trans、最大淋巴结短径、ADCmin值、血清CEA、CA199水平是直肠癌淋巴结转移的影响因素（P<0.05）。经过ROC分析得到K^trans、最大淋巴结短径、ADCmin值、血清CEA、CA199联合评估淋巴结转移均有一定的诊断价值，且联合检测的诊断效能最高（P<0.05）。结论K^trans、最大淋巴结短径、ADCmin值、血清CEA、CA199水平变化与直肠癌淋巴结转移有关，且上述参数联合检测的诊断效能更高。更多还原

【Abstract】 Objective To explore the value of dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）, diffusion-weighted imaging（DWI） combined with serum carcinoembryonic antigen（CEA） and carbohydrate antigen（CA199） levels in evaluating lymph node metastasis of rectal cancer, and to provide reference for preoperative evaluation of lymph node metastasis of rectal cancer. Methods The tumor markers and imaging data of 67 patients with rectal cancer who underwent surgery in Jiaozuo People’s Hospital from April 2019 to August 2024 and were pathologically confirmed were retrospectively analyzed, according to the postoperative pathological results, the patients were divided into two groups: lymph node metastasis positive group（24 cases）, and lymph node metastasis negative group（43 cases）. All patients had preoperative tumor marker information of CEA and CA199, as well as DCE-MRI and DWI scans, and measured the maximum short diameter of lymph nodes, ADCmin value and K^trans. Univariate and multivariate Logistic regression were used to analyze whether the above variables are risk factors for lymph node metastasis of rectal cancer, and the value of DCE-MRI, DWI parameters and tumor markers in the diagnosis of lymph node metastasis of rectal cancer was evaluated by ROC. Results There were significant differences in the maximum short diameter of lymph nodes, K^trans, ADCmin value, serum CEA and CA199 levels between lymph node metastasis positive group and lymph node metastasis negative group（P<0.05）. Multivariate Logistic analysis showed that the final maximum short diameter of lymph nodes, K^trans, ADCmin value, serum CEA and CA199 levels were the influencing factors of lymph node metastasis in rectal cancer（P<0.05）. The maximum short diameter of lymph nodes, K^trans, ADCmin value, serum CEA and CA199 obtained by ROC analysis all had certain diagnostic value, and the diagnostic efficiency of joint detection was the highest（P<0.05）. Conclusion The changes of K^trans, maximum lymph node short diameter, ADCmin value, serum CEA and CA199 levels are related to lymph node metastasis of rectal cancer, and the diagnostic efficiency of combined detection of the above parameters is higher.更多还原