Diagnostic value of multi-slice spiral CT combined with serum CA199 and CEA for colorectal cancer and metastasis
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摘要:
目的 探讨多层螺旋CT(MSCT)联合血清CA199、CEA检查对结直肠癌(CRC)及是否合并肝转移的诊断价值。 方法 回顾性选取2019年1月~2021年12月在本院经病理确诊的110例CRC患者为CRC组，以及110例肠道良性病变患者为良性病变组，对比两组患者的MSCT资料以及血清CA199、CEA水平，并结合病理诊断结果分析MSCT联合血清CA199、CEA对CRC及是否合并肝转移的诊断价值。 结果 两组患者的血清CA199、CEA水平差异具有统计学意义，CRC患者指标水平更高(P < 0.05);与病理诊断一致性检验，血清CA199、CEA水平和MSCT单独及联合诊断CRC的Kappa值分别为0.491、0.355、0.667、0.682，敏感度分别为84.54%、72.73%、91.82%、72.73%，特异性分别为64.55%、62.73%、74.55%、95.45%，准确率分别为74.55%、67.73%、83.18%、84.09%。是否合并肝转移CRC患者的血清CA199、CEA水平差异有统计学意义，合并肝转移患者指标水平更高(P < 0.05);与病理诊断一致性检验，血清CA199、CEA水平和MSCT单独及联合诊断CRC合并肝转移的Kappa值分别为0.408、0.353、0.445、0.726，敏感度分别为84.00%、72.00%、92.00%、72.00%，特异性分别为69.41%、71.76%、68.24%、96.47%，准确率分别为72.73%、71.82%、73.64%、90.91%。 结论 MSCT及血清CA199、CEA对CRC诊断各有优点及不足，两者联合检测有助于CRC的肝转移诊断。 Abstract:Objective To explore the diagnostic value of multi-slice spiral CT (MSCT) combined with serum CA199 and CEA for colorectal cancer (CRC) and liver metastases. Methods A total of 110 patients with CRC and 110 patients with benign intestinal lesions who were pathologically confirmed in the hospital from January 2019 to December 2021 were retrospectively selected as CRC group and benign lesion group, respectively. MSCT data and levels of serum CA199 and CEA in the two groups were compared and analyzed. Based on the results of pathological diagnosis, the diagnostic value of MSCT combined with serum CA199 and CEA in the diagnosis of CRC. The diagnostic value of for liver metastasis were analyzed. Results There were significant differences in serum CA199 and CEA levels in patients with colorectal cancer, and higher index levels in CRC patients (P < 0.05). The consistency test showed that kappa values, sensitivity, specificity and accuracy rates of serum CA199, CEA, MSCT and their combination in the diagnosis of CRC were 0.491, 0.355, 0.667, 0.682; 84.54%, 72.73%, 91.82%, 72.73%; 64.55%, 62.73%, 74.55%, 95.45% and 74.55%, 67.73%, 83.18%, 84.09%, respectively. Serum CA199 and CEA levels of CRC patients with or without liver metastasis were significantly different, and the levels of serum CA199 and CEA were higher in CRC patients with liver metastasis (P < 0.05). The results of kappa consistency test showed that kappa values, sensitivity, specificity and accuracy rates of serum CA199, CEA, MSCT and their combination in the diagnosis of liver metastases were 0.408, 0.353, 0.445, 0.726; 84.00%, 72.00%, 92.00%, 72.00%; 69.41%, 71.76%, 68.24%, 96.47% and 72.73%, 71.82%, 73.64%, 90.91%, respectively. Conclusion MSCT, serum CA199 and CEA have their own advantages and disadvantages in the diagnosis of CRC. The combined detection is conducive to the diagnosis of liver metastases in CRC. -
图 1 MSCT诊断CRC合并肝转移图像
A: 动脉期CRC(横断面); B: 静脉期CRC(横断面).
Figure 1. MSCT diagnosis of CRC with liver metastases.
图 2 MSCT诊断CRC合并肝转移图像
A: 动脉期CRC合并肝转移(横断面); B: 静脉期CRC合并肝转移(横断面).
Figure 2. MSCT diagnosis of CRC with liver metastases.
表 1 CRC组与良性病变组血清CA19-9、CEA水平比较
Table 1. Comparison of serum CA19-9 and CEA levels between CRC group and benign lesion group(n=110, Mean±SD)
组别 CA199(U/mL) CEA(ng/mL) CRC组 48.01±8.73 7.31±1.83 良性病变组 20.45±4.33 2.27±0.48 t 29.662 27.940 P < 0.001 < 0.001 CA199: 糖类抗原199; CEA: 癌胚抗原; CRC: 结直肠癌. 
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表 2 两组患者MSCT和血清CA199、CEA检测的阳性率
Table 2. Positive rates of MSCT and serum CA199 and CEA in the two groups
项目 病理诊断(n) Kappa 敏感度(%) 特异性(%) 准确度(%) 阳性 阴性 合计 CA199 0.491 84.54 64.55 74.55 阳性 93 39 132 阴性 17 71 88 合计 110 110 220 CEA 0.355 72.73 62.73 67.73 阳性 80 41 121 阴性 30 69 99 合计 110 110 220 MSCT 0.667 91.82 74.55 83.18 阳性 101 28 129 阴性 9 82 91 合计 110 110 220 联合检测 0.682 72.73 95.45 84.09 阳性 80 5 85 阴性 30 105 135 合计 110 110 220
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表 3 血清CA199、CEA水平与肝转移的关系
Table 3. Relationship between serum CA199 and CEA levels and liver metastasis (Mean±SD)
肝转移 CA199 (U/mL) CEA (ng/mL) 有(n =25) 51.62±8.73 8.07±1.31 无(n=85) 46.95±8.51 7.09±1.08 t 3.847 6.054 P < 0.001 < 0.001
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表 4 MSCT和血清CA199、CEA诊断CRC合并肝转移与病理结果对照
Table 4. Comparison of MSCT, serum CA199, CEA in the diagnosis of CRC complicated with liver metastasis and pathological results
项目 病理诊断(n) Kappa 敏感度(%) 特异性(%) 准确度(%) 阳性 阴性 合计 CA199 0.408 84.00 69.41 72.73 阳性 21 26 47 阴性 4 59 63 合计 25 85 110 CEA 0.353 72.00 71.76 71.82 阳性 18 24 42 阴性 7 61 68 合计 25 85 110 MSCT 0.445 92.00 68.24 73.64 阳性 23 27 50 阴性 2 58 60 合计 25 85 110 联合检测 0.726 72.00 96.47 90.91 阳性 18 3 21 阴性 7 82 89 合计 25 85 110
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