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目的:探讨n 18F-氟脱氧葡萄糖（FDG）PET/CT联合糖类抗原125 （CA125 ）、人附睾蛋白4(HE4）水平在复发性卵巢癌的诊断和腹膜转移预后评估中的应用价值。n 方法:回顾性分析2016年1月至2021年6月在郑州大学第一附属医院接受n 18F-FDG PET/CT显像的89例卵巢癌术后患者的影像学资料和临床资料，其中59例经组织病理学检查确诊为复发性卵巢癌患者[复发组，中位年龄51(26~82）岁]、30例卵巢癌术后经组织病理学检查确诊为良性腹膜增厚患者[未复发组，中位年龄55(34~79）岁]。所有患者均随访至少1年。分别计算n 18F-FDG PET/CT和CT增强诊断复发性卵巢癌及术后残端复发、腹膜转移、淋巴结转移、腹腔外其他转移灶的效能。绘制n 18F-FDG PET/CT、CA125、HE4及其联合检测复发性卵巢癌的受试者工作特征曲线，并分析不同检查方法诊断复发性卵巢癌的效能。诊断效能之间的比较采用n χ2检验。采用Cox模型进行多因素预后分析，评估多种因素对复发性卵巢癌患者预后的影响并计算95%置信区间（n CI）。采用Kaplan-Meier生存曲线分析单个预后因素对复发性卵巢癌患者总生存期的影响。n 结果:18F-FDG PET/CT诊断复发性卵巢癌的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为93.22%（55/59）、93.33%（28/30）、93.26%（83/89）、96.49%（55/57）、87.50%（28/32），高于增强CT[79.66%（47/59）、73.33%（22/30）、77.52%（69/89）、85.46%（47/55）、64.71%（22/34）]，各项之间的差异均有统计学意义（n χ2=4.193~8.828，均n P<0.05），同时，n 18F-FDG PET/CT对术后残端复发、腹膜转移、淋巴结转移的诊断效能（除腹膜转移阳性预测值、淋巴结转移灵敏度及阳性预测值外）均高于增强CT（n χ2=2.885~8.868，均n P<0.05 ）。n 18F-FDG PET/CT联合CA125及HE4诊断复发性卵巢癌的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为98.31% （58/59）、96.67%（29/30）、97.75%（87/89）、98.31%（58/59）、96.67%（29/30），高于三者单独应用或CA125+HE4联合应用，除n 18F-FDG PET/CT单独应用外，其他各项之间的差异均有统计学意义（n χ2=5.192~27.101，均n P<0.05），最大标准化摄取值的诊断临界值为5.60，血清CA125的诊断临界值为91.80 U/mL，HE4的诊断临界值为196.89 pmol/L。腹膜转移是复发性卵巢癌的预后独立影响因素（95%n CI：3.784~819.477，n P=0.003），腹膜转移阴性患者的总生存期明显高于腹膜转移阳性患者（n χ2=30.320，n P<0.001），腹膜转移病灶多分布于腹膜种植转移易感区。n 结论:18F-FDG PET/CT在复发性卵巢癌复发诊断及转移灶评估中的效能优于增强CT；其代谢参数与血清肿瘤学标志物联合应用，可以提高对复发性卵巢癌的诊断效能。n “,”Objective:To explore the application value of n 18F-fluorodeoxyglucose (FDG) PET/CT combined with carbohydrate antigen 125 (CA125) and human epididymal protein 4 (HE4) levels in the diagnosis of recurrent ovarian cancer and prognostic evaluation of peritoneal metastasis.n Methods:The imaging data of 89 postoperative ovarian cancer patients who underwent n 18F-FDG PET/CT in the First Affiliated Hospital of Zhengzhou University from January 2016 to June 2021 were retrospectively analyzed. Pathological examinations diagnosed 59 patients with recurrent ovarian cancer (recurrence group, median age: 51(26-82) years), whereas 30 patients with ovarian cancer were diagnosed with benign peritoneal thickening by histopathological examination after surgery (non-recurrence group, median age: 55(34-79) years). All patients were followed up for at least 1 year. The efficacy of n 18F-FDG PET/CT and contrast-enhanced CT in the diagnosis of recurrent ovarian cancer and postoperative stump recurrence, peritoneal metastasis, lymph node metastasis, and other metastases outside the abdominal cavity was calculated. The receiver operator characteristic curve of n 18F-FDG PET/CT, CA125, HE4 alone, and combined detection of recurrent ovarian cancer was obtained, and the efficacy of independent or combined detection of recurrent ovarian cancer was analyzed. Comparison of diagnostic efficency used n χ2 text. The Cox model was used for multivariate prognostic analysis to evaluate the influence of multiple factors on the prognosis of patients with recurrent ovarian cancer and calculate the 95% confidence interval (n CI). Kaplan-Meier survival curve was used to analyze the influence of a single prognostic factor on the overall survival of patients with recurrent ovarian cancer.n Results:The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value ofn 18F-FDG PET/CT in diagnosing recurrent ovarian cancer were 93.22%(55/59), 93.33%(28/30), 93.26%(83/89), 96.49%(55/57) and 87.50%(28/32), respectively, which were higher than those of contrast-enhanced CT (79.66%(47/59), 73.33%(22/30), 77.52%(69/89), 85.46%(47/55), and 64.71% (22/34)). The differences among all items were statistically significant (n χ2=4.193-8.828, all n P<0.05). In addition, the diagnostic efficacy ofn 18F-FDG PET/CT for postoperative stump recurrence, peritoneal metastasis, and lymph node metastasis (except the positive predictive values of peritoneal metastasis, sensitivity, and lymph node metastasis) were all higher than those of the contrast-enhanced CT (n χ2=2.885-8.868, all n P<0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value ofn 18F-FDG PET/CT combined with CA125 and HE4 in the diagnosis of recurrent ovarian cancer were 98.31%(58/59), 96.67%(29/30), 97.75%(87/89), 98.31%(58/59), and 96.67%(29/30), respectively, which were higher than the three methods were applied alone or two combined applications, except for the application of n 18F-FDG PET/CT alone, the differences between the other items were statistically significant (n χ2=5.192-27.101, all n P<0.05). The diagnostic cut-off values of standardized uptake, serum CA125, and HE4 were 5.60, 91.80 U/mL, and 196.89 pmol/L, respectively. Peritoneal metastasis is an important independent prognostic factor for recurrent ovarian cancer (95%n CI: 3.784-819.477, n P=0.003). The overall survival of patients with negative peritoneal metastasis was significantly higher than that of patients with positive peritoneal metastasis (n χ2=30.320, n P<0.001). Peritoneal metastasis lesions were mostly distributed in the susceptible area of peritoneal implantation and metastasis.n Conclusions:18F-FDG PET/CT performs better than contrast-enhanced CT in recurrence diagnosis and metastasis assessment of recurrent ovarian cancer. n 18F-FDG PET/CT metabolic parameters, serum tumor markers, and the combined use of drugs can improve the diagnostic efficiency for recurrent ovarian cancer.n