Although CT is not sensitive for detecting pleural metastases, these can be verified by video-assisted thoracoscopy, if needed [70]. Preoperative detection by CT of a moderate-to-large pleural effusion helps predict poor post-treatment outcome [71]. For postsurgical surveillance, the yield of chest CT is low if the chest radiograph shows no abnormalities, CT shows no abdominal or pelvic disease, and there is no rising serum CA-125 [72,73]. If PET using tracer FDG is used and includes chest, abdomen, and pelvis, the added value of diagnostic-quality chest CT is probably even lower. MRI MRI is an excellent problem-solving technique by virtue of its ability to define common conditions such as fibroids, dermoid cysts, endometriomas, and other benign lesions [6-8,31,44]. A multivariable analysis showed that the accuracy of MRI with gadolinium enhancement in separating ovarian malignancy from other types of adnexal masses was 93% [74]. Gadolinium enhancement and diffusion-weighted imaging offer improved diagnostic confidence and tissue characterization [31,74]. In staging, MRI has been shown to provide equivalent accuracy to CT and to predict peritoneal tumor volume comparable with surgery, with sensitivity of 0.88, specificity of 0.74, and accuracy of 0.84 [75,76]. However, the role of MRI in staging has been limited because 1) the use of intraluminal gastrointestinal contrast agents with MRI is not routine as it is with CT, and 2) patient motion is a greater problem for MRI than for CT. Although CT is currently the modality of choice for staging ovarian cancer, MRI is recommended for patients with borderline tumors or ovarian cancers that have been previously staged with fertility preservation (to minimize ionizing radiation exposure), or for some patients whose CT findings are inconclusive [68,77]. Higher-field MRI scans may improve the accuracy of MRI for staging ovarian cancer pending further investigation [78].
Staging and Follow up of Ovarian Cancer. Although CT is not sensitive for detecting pleural metastases, these can be verified by video-assisted thoracoscopy, if needed [70]. Preoperative detection by CT of a moderate-to-large pleural effusion helps predict poor post-treatment outcome [71]. For postsurgical surveillance, the yield of chest CT is low if the chest radiograph shows no abnormalities, CT shows no abdominal or pelvic disease, and there is no rising serum CA-125 [72,73]. If PET using tracer FDG is used and includes chest, abdomen, and pelvis, the added value of diagnostic-quality chest CT is probably even lower. MRI MRI is an excellent problem-solving technique by virtue of its ability to define common conditions such as fibroids, dermoid cysts, endometriomas, and other benign lesions [6-8,31,44]. A multivariable analysis showed that the accuracy of MRI with gadolinium enhancement in separating ovarian malignancy from other types of adnexal masses was 93% [74]. Gadolinium enhancement and diffusion-weighted imaging offer improved diagnostic confidence and tissue characterization [31,74]. In staging, MRI has been shown to provide equivalent accuracy to CT and to predict peritoneal tumor volume comparable with surgery, with sensitivity of 0.88, specificity of 0.74, and accuracy of 0.84 [75,76]. However, the role of MRI in staging has been limited because 1) the use of intraluminal gastrointestinal contrast agents with MRI is not routine as it is with CT, and 2) patient motion is a greater problem for MRI than for CT. Although CT is currently the modality of choice for staging ovarian cancer, MRI is recommended for patients with borderline tumors or ovarian cancers that have been previously staged with fertility preservation (to minimize ionizing radiation exposure), or for some patients whose CT findings are inconclusive [68,77]. Higher-field MRI scans may improve the accuracy of MRI for staging ovarian cancer pending further investigation [78].