Application Value Of Multimodal Magnetic Resonance Imaging Combined With Serum CA125 And HE4 In Differentiating Benign And Malignant Ovarian Tumors

Objective:To investigate the diagnostic value of multimodal magnetic resonance imaging combined with serum tumor markers CA125and HE4 in benign and malignant ovarian tumors.In addition,the apparent diffusion coefficient（ADC）,Dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）and serum tumor markers CA125 and HE4 were used as quantitative and semi-quantitative indicators for the differential diagnosis of benign and malignant ovarian tumors.Therefore,it provides important guidance for clinical selection of appropriate treatment plan.Methods:The clinical and imaging data of 142 patients with ovarian tumor confirmed by operation and pathology were retrospectively analyzed,all patients underwent routine MR examination,dynamic enhancement examination,serum CA125 and HE4 detection before surgery.Among them,there were 84 benign tumors and 58 malignant tumors.The ADC values of solid and cystic components,the types of dynamic enhanced scanning time-signal intensity curve（TIC）of solid components,serum CA125 and HE4 levels of benign ovarian tumors and malignant ovarian tumors were compared.The preoperative multimodal magnetic resonance examination,serum CA125 and serum HE4 in the diagnosis of benign and malignant ovarian tumors were compared with the postoperative pathological results of paraffin section（gold standard）,the sensitivity,specificity,accuracy and predictive value of single and combined diagnosis were calculated.Results:（1）Comparative analysis of general data of patients with benign and malignant ovarian tumors:the age difference between the two groups was statistically significant（P<0.05）,the average age of patients with malignant tumors was higher than that of those with benign tumors;There was no statistical significance in menopause and average length diameter of tumor between two groups（the P values are all greater than0.05）.（2）Comparison and analysis of multimodal MRI results in patients with benign and malignant ovarian tumors:there was no statistical significance in ADC values of tumor cystic components between the two groups（P>0.05）,the difference in ADC values of solid components of tumor was statistically significant（P<0.05）,the area under the ROC curve（AUC）was 0.815,the optimal diagnostic threshold was 0.822×10^-3mm²/s,the sensitivity was 77.6%,the specificity was 80.0%,and the Youden index was 57.6%.The difference in the distribution of the solid component of tumor in different TIC type ratio between the two groups was statistically significant（P<0.05）,benign tumors were more common with type I curve,malignant tumors were more common in type II and type III curves.（3）Comparison of serum CA125 and HE4 levels in patients with benign and malignant ovarian tumors:there were statistically significant differences in serum CA125 and HE4 levels between two groups（the P values are all less than 0.05）,serum CA125and HE4 levels in patients with malignant tumor were significantly higher than those in benign tumor group;Patients with benign tumors,there was no statistically significant difference in serum CA125 level before and after menopause（P>0.05）,but there was statistically significant difference in serum HE4 level before and after menopause（P<0.05）,serum HE4 level in postmenopausal patients was higher than that before menopause.Patients with malignant tumors,there were no significant differences in serum CA125 and HE4 levels before and after menopause（the P values are all greater than 0.05）.（4）Single serum CA125,serum HE4,multimodal MRI and the combination of the three methods were respectively consistent with the pathological diagnosis:the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of single serum CA125 in the diagnosis of benign and malignant ovarian tumors were 67.2%,79.8%,69.6%,77.9%and 74.6%;The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of single serum HE4 in the diagnosis of benign and malignant ovarian tumors were 55.2%,98.8%,96.9%,76.1%and 80.9%;The sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 68.9%,90.5%,83.3%,80.9%and 81.7%for the diagnosis of benign and malignant ovarian tumors by single multimodal magnetic resonance examination;The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of multimodal MRI combined with serum CA125 and HE4 in the diagnosis of benign and malignant ovarian tumors were 84.5%,97.6%,96.1%,90.1%and92.2%;kappa’s coefficient:multimodal MRI combined with serum CA125 and HE4（0.837）>single multimodal MRI（0.611）>single serum HE4（0.578）>single serum CA125（0.473）,the sensitivity,negative predictive value and accuracy of combined detection were all higher than that of single detection method.Conclusion:In benign and malignant ovarian tumors,tumor solid component ADC value is of great significance in qualitative diagnosis of ovarian tumors.DCE-MRI shows that different curve types are valuable for the differential diagnosis of benign and malignant tumors.Serum CA125 and HE4 levels contribute to the differentiation of benign and malignant ovarian tumors.Combined multimodal magnetic resonance examination,serum CA125 and HE4 can improve the efficacy of preoperative differential diagnosis of benign and malignant ovarian tumors.