弥散加权成像结合血清VEGF、CCNA2、AFP-L3水平诊断结直肠癌肝转移的临床价值

摘要/Abstract

摘要： 目的探讨弥散加权成像(DWI)结合血清血管内皮生长因子(VEGF)、细胞周期蛋白A2(CCNA2)、甲胎蛋白异质体-L3(AFP-L3)水平,在诊断结直肠癌(CRC)肝转移中的临床价值。方法选取2021年3月至2024年4月在榆林市第一医院影像科接受治疗的160例CRC患者为研究对象,其中发生肝转移者31例为转移组,未发生肝转移者129例为未转移组。所有患者均接受MRI+DWI检查,并检测血清VEGF、CCNA2、AFP-L3水平。比较两组患者的影像学特点、表观弥散系数(ADC)及血清学指标水平。结果肝转移灶在T₂WI上呈等或稍高信号,部分信号不均匀,边缘呈毛刺或分叶状,T₁WI呈等或稍低信号,DWI呈明显高信号,ADC图呈低信号。转移组ADC值低于未转移组[(0.87±0.11)10^-3 s/mm² vs.(1.02±0.13)10^-3 s/mm²],差异有统计学意义(t=5.931,P<0.05),且转移组血清VEGF、CCNA2、AFP-L3水平高于未转移组[(313.47±49.29)pg/mL vs. (186.24±31.89)pg/mL、(2 430.84±471.75)pg/mL vs. (1 598.40±220.86)pg/mL、(83.37±40.70)μg/L vs. (9.47±3.79)μg/L],差异均有统计学意义(t分别为13.699、9.576、10.099,均P<0.05)。CRC肝转移患者中,混合型ADC值低于促结缔组织增生型和浸润型[(0.77±0.07)10^-3 s/mm² vs. (0.88±0.11)10^-3 s/mm²、(0.77±0.07)10^-3 s/mm² vs. (0.94±0.12)10^-3 s/mm²],差异均有统计学意义(t分别为2.565、3.780,均P<0.05),且三亚型血清VEGF、CCNA2、AFP-L3水平差异无统计学意义(P>0.05)。ROC曲线结果显示,MRI的灵敏度为74.19%,特异度为81.40%,准确率为80.00%,Kappa值为0.465。MRI结合DWI的灵敏度为77.42%,特异度为89.92%,准确率为87.50%,Kappa值为0.627。当MRI+DWI联合血清VEGF、CCNA2、AFP-L3时,灵敏度提升至96.77%,特异度达到99.22%,准确率为98.75%,Kappa值高达0.960,显示出极高的一致性和可靠性。结论 MRI结合DWI与血清VEGF、CCNA2、AFP-L3的联合诊断方法在CRC肝转移的检测中表现出极高的诊断效能。与单独使用MRI或DWI相比,联合诊断方法显示出更高的灵敏度和特异度。

关键词: MRI扩散成像, 血清VEGF, CCNA2, AFP-L3, 结直肠癌, 肝转移

Abstract: Objective To explore the clinical value of magnetic resonance (MRI) diffusion imaging (DWI) combined with serum vascular endothelial growth factor (VEGF), cyclin A2 (CCNA2), and alpha-fetoprotein-L3 (AFP-L3) levels in the diagnosis of colorectal cancer (CRC) liver metastasis. Methods A total of 160 patients with colorectal cancer who were treated at the Imaging Department of Yulin First Hospital from March 2021 to April 2024 were selected as subjects, including 31 cases with liver metastasis in the metastasis group, and 129 cases without liver metastasis in the non-metastasis group. All patients underwent MRI+DWI examination, and serum VEGF, CCNA2, and AFP-L3 levels were measured. The imaging characteristics, apparent diffusion coefficient (ADC), and serum marker levels of these two groups of patients were compared. Results Liver metastases appear as iso- or slightly hyperintense signals on T₂-weighted imaging (T₂WI), with some areas showing uneven signals and margins that may be spiculated or lobulated. On T₁-weighted imaging (T₁WI), they exhibit iso- or slightly hypointense signals, while they show markedly hyperintense signals on diffusion-weighted imaging (DWI) and low signals on the ADC map. The ADC values in the metastatic group are significantly lower than those in the non-metastatic group [(0.87±0.11) × 10^-3 s/mm² vs. (1.02±0.13) × 10^-3 s/mm²], with a statistically significant difference (t=5.931, P＜0.05). Furthermore, the serum levels of VEGF, CCNA2, and AFP-L3 in the metastatic group are higher than those of the non-metastatic group [(313.47±49.29) pg/mL vs. (186.24±31.89) pg/mL; (2 430.84±471.75) pg/mL vs. (1 598.40±220.86) pg/mL; (83.37±40.70) μg/L vs. (9.47±3.79) μg/L, respectively], with all differences being statistically significant (t=13.699, 9.576, 10.099, all P＜0.05). In CRC patients with liver metastases, the mixed-type ADC values are lower than those of the desmoplastic and infiltrative types [(0.77±0.07) × 10^-3 s/mm² vs. (0.88±0.11) × 10^-3 s/mm² and (0.77±0.07) × 10^-3 s/mm² vs. (0.94±0.12) × 10^-3 s/mm²], with statistically significant differences (t=2.565, 3.780, both P＜0.05). However, there are no statistically significant differences in serum levels of VEGF, CCNA2, and AFP-L3 among the three subtypes (P＞0.05). ROC curve analysis results showed that the sensitivity, specificity, accuracy, and Kappa value of MRI diagnosis were 74.19%, 81.40%, 80.00%, and 0.465, respectively. The sensitivity, specificity, accuracy, and Kappa value of MRI combined with DWI were 77.42%, 89.92%, 87.50%, and 0.627, respectively. When MRI, DWI, and serum VEGF, CCNA2, and AFP-L3 were used together, the sensitivity, specificity, accuracy, and Kappa value increased to 96.77%, 99.22%, 98.75%, and 0.960, respectively, showing very high consistency and reliability. Conclusion This study demonstrates that the combined diagnostic method of MRI with DWI and serum levels of VEGF, CCNA2, and AFP-L3 exhibits excellent diagnostic performance in detecting colorectal cancer liver metastasis. Compared to the use of MRI or DWI alone, the combined approach showing higher sensitivity and specificity.

Key words: MR diffusion imaging, Serum VEGF, CCNA2, AFP-L3, Colorectal cancer, Liver metastasis

张帅帅, 杨永东. 弥散加权成像结合血清VEGF、CCNA2、AFP-L3水平诊断结直肠癌肝转移的临床价值[J]. 肝脏, 2026, 31(1): 30-34.

ZHANG Shuai-shuai, YANG Yong-dong. The clinical value of MR diffusion imaging combined with serum VEGF, CCNA2, and AFP-L3 Levels in the diagnosis of colorectal cancer liver metastases[J]. Chinese Hepatolgy, 2026, 31(1): 30-34.

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