目的 分析MR扩散成像(DWI)结合 血清Ⅳ型胶原(COLⅣ)、癌胚抗原(CEA)水 平在诊断结直肠癌肝转移中的临床价值。 方法 选取2016年7月至2018年2月我院收 治的结直肠癌患者370例为研究对象，将 发生肝转移者纳入转移组(n=50)，未转 移者纳入未转移组(n=320)，均接受常规 MRI、MRI+DWI检查(b=0、1000s/mm2 )，分 析MRI影像特点、表观扩散系数(ADC)，并 检测两组血清COLⅣ、CEA水平，对比肝 转移不同亚型患者ADC与血清COLⅣ、CEA 水平，分析MRI+DWI结合血清学指标的诊 断效能。结果 肝转移灶在MRI 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上呈等或稍低信 号，在DWI上呈明显高信号，在ADC图上 呈低信号；b=1000s/mm2 时，转移组ADC低 于未转移组，且转移组血清COLⅣ、CEA 水平高于未转移组(P＜0.05)；结直肠癌 肝转移患者中，混合型ADC低于促结缔组 织增生型、推压型，促结缔组织增生型 ADC低于推压型(P＜0.05)，而三亚组血清 COLⅣ、CEA水平比较差异无统计学意义(P ＞0.05)；MRI+DWI联合血清COLⅣ、CEA诊 断结直肠癌肝转移的灵敏度、特异度、准 确度、kappa值分别为92.00%、89.06%、 89.46%、0.643，均高于MRI、MRI+DWI诊 断(P＜0.05)。结论 MRI+DWI联合血清 COLⅣ、CEA可较好诊断结直肠癌肝转移， 值得临床推广实践。

Objective To analyze the clinical value of MR diffusion weighted imaging (DWI) combined with serum type IV collagen (COLIV) and carcinoembryonic antigen (CEA) levels in the diagnosis of hepatic matastasis of colorectal cancer. Methods A total of 370 patients with colorectal cancer who were admitted to the hospital during the period from July 2016 to February 2018 were selected as subjects. Patients with hepatic metastases were included in the metastasis group (n=50), and those without were included in the non-metastasis group (n=320). All patients underwent routine MRI and MRI+DWI examinations (b=0, 1000s/mm2 ). The characteristics of MRI images and the apparent diffusion coefficient (ADC) were analyzed. Serum COLIV and CEA levels in both groups were detected. The ADC and serum COLIV and CEA levels were compared among patients with different subtypes of hepatic metastases. The diagnostic efficiency of MRI+DWI combined with serological indicators was analyzed. Results Hepatic metastases showed equal or slightly high signal on T2WI. The signal of some lesions were inhomogeneous, the edges were burred or lobulated. MRI showed equal or slightly lower signals on T1WI, high signal on DWI, low signal on ADC image. When the b value was 1000s/mm2 , the ADC in the metastasis group was lower than that in the non-metastasis group, and serum COLIV and CEA levels in the metastasis group were higher than those in the non-metastasis group (P<0.05). The ADC value of mixed type was less than the desmoplastic type, and less than the push type (P<0.05), while there was no statistically difference in the levels of serum COLIV and CEA among the three subgroups (P>0.05). The sensitivity, specificity, accuracy and kappa value of MRI+DWI combined with serum COLIV and CEA in diagnosis of hepatic matastasis of colorectal cancer were 92.00%, 89.06%, 89.46% and 0.643 relatively, which were higher than those of MRI or MRI + DWI (P<0.05). Conclusion MRI+DWI combined with serum COLIV and CEA can be used to diagnose hepatic matastasis of colorectal cancer.