The value of apparent diffusion coefficient combined with serum carbohydrate antigen 199 in the diagnosis and staging of pancreatic cancer
LI Hui,TIAN Chunjiang,ZHANG Xiang
Department of Radiology, Nankai Hospital, Tianjin 300100, China
Abstract:
Objective To investigate the diagnostic value and efficacy of diffusion weighted imaging (DWI), apparent diffusion coefficient (ADC), serum carbohydrate antigen 199 (CA199) and serum carcinoembryonic antigen (CEA) in pancreatic cancer and their correlation in clinical staging. Methods Retrospective analysis of 263 patients who underwent pancreatic MRI examination in Nankai Hospital of Tianjin from March 2020 to September 2021. According to the standard of excretion, there were 83 patients with pancreatic cancer (including 21 patients with stage Ⅰ, 30 patients with stage Ⅱ, 32 patients with stage Ⅲ+Ⅳ), 56 patients with chronic pancreatitis and 61 patients with normal pancreas. DWI sequence signal, ADC value and serum CA199 and CEA values were detected respectively. The values of ADC, serum CA199 and CEA were compared among the five groups. The ROC curves of ADC, serum CA199, CEA and their combination in the diagnosis of pancreatic cancer were drawn. The clinical stages of the patients were counted and the correlation between ADC value, serum CA199 value, CEA value and clinical stage was analyzed. Results The average ADC value of stage I pancreatic cancer [(1.28±0.15)×10-3 mm2/s] was lower than that of normal pancreas group [(1.52±0.14)×10-3 mm2/s]. The average ADC values of Ⅱ and Ⅲ+Ⅳ stages of pancreatic cancer [(1.09±0.07)×10-3mm2/s)] and [(0.89±0.10)×10-3 mm2/s] were lower than those of normal pancreas, chronic pancreatitis [(1.35±0.12)×10-3 mm2/s] and stage Ⅰ pancreatic cancer. The average ADC value of pancreatic cancer in stage Ⅲ+Ⅳ was significantly lower than that in stage Ⅱ (P<0.05). The average serum CA199 level in chronic pancreatitis group [(34.14 ±24.26)U/ml] and pancreatic cancer stage I [(39.88±13.10) U/ml] was higher than that in normal pancreas group [(7.63 ±5.38) U/ml]. The average serum CA199 values of Ⅱ and Ⅲ+Ⅳ stage of pancreatic cancer [(137.86±100.72)U/ml] and [(342.16±101.98)U/ml] were higher than those of normal pancreas, chronic pancreatitis and stage Ⅰ pancreatic cancer. The average serum CA199 value in Ⅲ+Ⅳ stage of pancreatic cancer was significantly higher than that in Ⅱ stage(P<0.05). The average serum CEA level in chronic pancreatitis group [(6.27±3.21) ng/ml], pancreatic cancer stage Ⅰ [(7.37±1.82) ng/ml] and Ⅱ [(9.67±0.66) ng/ml] was higher than that in normal pancreas group [(2.21±0.51) ng/ml]. The mean serum CEA level of pancreatic cancer in stage Ⅲ+Ⅳ [(15.80±2.83)ng/ml] was significantly higher than that in normal pancreas, chronic pancreatitis, stage Ⅰ and Ⅱ of pancreatic cancer (P<0.05). The AUC of ADC value, serum CA199 and CEA value in the diagnosis of pancreatic cancer were 0.88, 0.89, 0.85, respectively, and their sensitivity were 87.31%, 93.10%, 89.19%; specificity were 91.50%, 89.37%, 88.54%. The AUC, sensitivity and specificity for the diagnosis of pancreatic cancer were 0.95, 96.79% and 97.61%, respectively. The diagnostic thresholds of pancreatic cancer were ADC:1.26×10-3 mm2/s, CA199:49.87 U/ml and CEA:5.69 ng/ml, respectively. ADC value was negatively correlated with clinical stage of pancreatic cancer (r=-0.773), while serum CA199 value was positively correlated with clinical stage of pancreatic cancer (r=0.812), the level of serum CEA was positively correlated with the clinical stage of pancreatic cancer (r=0.625, P<0.05). Conclusion ADC decreased in pancreatic cancer, serum CA199 and CEA increased in pancreatic cancer and chronic pancreatitis. ADC combined with serum CA199 and CEA is of high value in the diagnosis of pancreatic cancer. The values of ADC, serum CA199 and CEA were all related to the clinical stage of pancreatic cancer.
