Imaging of ovarian cancer

Forstner, Rosemarie; Chen, Min; Hricak, Hedvig

doi:10.1002/jmri.1880050521

Cited by 32 publications

(13 citation statements)

References 61 publications

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“…Unfortunately, gynecologic oncologists see less than half of ovarian cancer patients [46]. Is has been reported that up to 40% of cases are thought to actually be of a lower stage than they determined to be at their initial laparotomy [1,47,48,49]. Whatever the modality used, the correct staging of ovarian cancer with imaging studies is important in the determination of the appropriate referral to gynecologic oncologists, and thus to obtain a longer survival [18].…”

Section: Management Strategymentioning

confidence: 97%

Ovarian cancer: the clinical role of US, CT, and MRI

Togashi

2003

Eur Radiol

116

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This article presents an overview of ovarian cancer, which addresses the clinical roles of imaging studies, including US, CT, and MR imaging in the course of diagnosis and treatment of this important disease. US is the modality of choice in the evaluation of patients with suspected adnexal masses. Although its accuracy is not sufficient to avert surgery, morphological analysis of adnexal masses with US helps narrow the differential diagnosis, determining the degree of suspicion for malignancy, usually in concert with a serum CA-125 level. Combined morphological and vascular imaging obtained by US appear to further improve the preoperative assessment of adnexal masses. For uncertain or problematic cases, MR imaging helps to distinguish benign from malignant, with an overall accuracy for the diagnosis of malignancy of 93%. The accuracy of MR imaging in the confident diagnosis of mature cystic teratoma, endometrial cysts, and leiomayomas is very high. CT is not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination, except for fatty tissue and for calcification, and the disadvantages of irradiation. In the staging of ovarian cancer, CT, US, and MR imaging all have a similarly high accuracy. Although it is difficult to suggest a simple algorithm for evaluating the state of women with adnexal masses, the correct preoperative diagnosis and staging of ovarian cancer with the use of any of these imaging studies will lead to an appropriate referral to a specialist in gynecologic oncology and offer a significant survival advantage for patients with ovarian cancer.

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Section: Management Strategymentioning

confidence: 97%

Ovarian cancer: the clinical role of US, CT, and MRI

Togashi

2003

Eur Radiol

116

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“…However, secondary findings suggestive of malignancy such as pelvic organ and pelvic side wall invasion; peritoneal, omental, or mesenteric involvement; ascites; and lymphadenopathy increase the confidence in a diagnosis of malignancy (10). When these secondary criteria are used in addition to the primary criteria, the reported accuracy of CT in characterization of ovarian tumors as benign versus malignant is 92%-94% (39,41).…”

Section: Local Extensionmentioning

confidence: 97%

“…The proportion of malignant tumors increases with age: Before 20 years of age, malignant tumors represent 4% of all ovarian neoplasms; however, after 50 years of age, this proportion increases to 40% (8). The germ cell tumors represent two-thirds of ovarian malignancies in females less than 20 years of age (10). This article focuses on the evaluation of epithelial ovarian tumors.…”

Section: Classification Of Primary Ovarian Tumorsmentioning

confidence: 99%

CT of Epithelial Ovarian Tumors

Kawamoto¹,

Urban²,

Fishman³

1999

RadioGraphics

116

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Ovarian cancer is the second most common gynecologic malignancy in the United States and causes more deaths than any other cancer of the female reproductive system. Approximately two-thirds of patients have tumors that have spread beyond the pelvis at the time of diagnosis. Ovarian tumors arise from the surface epithelium or mesothelium, germ cells, or the gonadal stroma. Epithelial ovarian tumors include serous, mucinous, endometrioid, clear cell, and undifferentiated tumors. In general, the likelihood of malignancy increases with increasing solid-tissue elements and thicker septa. Surgery is central to the management of ovarian cancer. At the initial exploratory laparotomy, surgicopathologic staging and debulking of the tumor are undertaken. Patients with advanced cancer frequently undergo second-look surgery after chemotherapy to detect any residual disease. CT can provide staging information for preoperative planning and determination of surgical resectability, demonstrate tumor response to therapy, and allow detection of persistent or recurrent disease. However, a major limitation of CT is the lack of sensitivity for detection of small tumor implants, especially on the small intestine or mesentery. Dedicated CT of the pelvis is best performed with spiral CT. Ovarian carcinoma can spread by means of intraperitoneal implantation, lymphatic invasion, and hematogenous dissemination.

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“…Although the entire abdomen and pelvis are explored, certain sites are difficult to evaluate at surgery. These sites are the diaphragm, splenic hilum, stomach, lesser sac, liver, and mesenteric root and the paraaortic nodes above the renal vessels (3,7). Consequently, detection of lesions at these sites is clinically helpful.…”

Section: Role Of Imagingmentioning

confidence: 98%

“…The majority of women have advanced disease at presentation (7). Tumor is limited to the ovaries in stage I disease and extends into the pelvic tissues in stage II disease; there are extrapelvic implants in stage III disease and distant or parenchymal liver metastases in stage IV disease (Table 1) (8).…”

Section: Clinical Backgroundmentioning

confidence: 99%

Multidetector CT of Peritoneal Carcinomatosis from Ovarian Cancer

Bristow²,

et al. 2003

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Ovarian cancer is usually in an advanced stage at diagnosis due to the presence of peritoneal carcinomatosis, which develops as a result of peritoneal fluid circulation. Tumor implants of varying size can occur anywhere from the diaphragm through the pelvis. Computed tomography (CT) can be used to detect these metastatic lesions, which can be miliary or large and appear as soft-tissue or low-attenuation masses. Recent advances in CT technology have increased the flexibility of image acquisition, thereby allowing the use of thin sections and multiplanar reformatting. With multidetector CT, thin-section images of the abdomen and pelvis can be obtained to assess for subcentimeter implants and to create three-dimensional images with reduced artifact. Multiplanar reformatting can be used to confirm the presence of implants. Structures such as the diaphragm, paracolic gutters, bowel, and cul-de-sac can be evaluated in multiple planes for surface nodularity and small implants. Interactive multiplanar review of the abdomen and pelvis has the potential to improve detection of peritoneal metastases at CT.

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Imaging of ovarian cancer

Cited by 32 publications

References 61 publications

Ovarian cancer: the clinical role of US, CT, and MRI

Ovarian cancer: the clinical role of US, CT, and MRI

CT of Epithelial Ovarian Tumors

Multidetector CT of Peritoneal Carcinomatosis from Ovarian Cancer

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