CT Contrast-enhanced CT (also using oral contrast) is the modality of choice for detecting recurrence in the chest, abdomen, or pelvis. Contrast-enhanced CT has a reported sensitivity ranging from 58% to 84% and specificity in the range of 59% to 100% in identifying tumor recurrence [52,86,87]. Recurrent disease usually manifests as peritoneal implants; within the peritoneal cavity and on the surface of the visceral organs. CT is used to identify tumor deposits in the root of the mesentery, gastrosplenic ligament, omentum of the lesser sac, porta hepatis, intersegmental fissure of the liver, diaphragm, liver dome, and lung parenchyma, and also in detecting lymphadenopathy. However, identification of small (<5 mm) tumor deposits in the mesentery, on bowel wall, or along the peritoneum may be limited [5,43,58,59]. Noncontrast-enhanced CT of the abdomen and pelvis offers limited ability to identify small peritoneal or mesenteric implants, or lymphadenopathy among bowel loops and other adjacent organs. MRI The reported accuracy of MRI for detecting lesions >2 cm in recurrent disease is comparable to that of CT at 93% to 95% [14]. However, MRI demonstrated a significantly lower area under the receiver operator characteristic curve than CT, FDG-PET, FDG-PET/CT, or CA-125 for overall detection of recurrent ovarian cancer in a meta- analysis [88]. CT remains the most widely used imaging method for detecting recurrence, and, despite some advantages, the role of MRI in follow-up imaging 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 suspected recurrence of ovarian cancer, MRI is recommended for 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.
Staging and Follow up of Ovarian Cancer. CT Contrast-enhanced CT (also using oral contrast) is the modality of choice for detecting recurrence in the chest, abdomen, or pelvis. Contrast-enhanced CT has a reported sensitivity ranging from 58% to 84% and specificity in the range of 59% to 100% in identifying tumor recurrence [52,86,87]. Recurrent disease usually manifests as peritoneal implants; within the peritoneal cavity and on the surface of the visceral organs. CT is used to identify tumor deposits in the root of the mesentery, gastrosplenic ligament, omentum of the lesser sac, porta hepatis, intersegmental fissure of the liver, diaphragm, liver dome, and lung parenchyma, and also in detecting lymphadenopathy. However, identification of small (<5 mm) tumor deposits in the mesentery, on bowel wall, or along the peritoneum may be limited [5,43,58,59]. Noncontrast-enhanced CT of the abdomen and pelvis offers limited ability to identify small peritoneal or mesenteric implants, or lymphadenopathy among bowel loops and other adjacent organs. MRI The reported accuracy of MRI for detecting lesions >2 cm in recurrent disease is comparable to that of CT at 93% to 95% [14]. However, MRI demonstrated a significantly lower area under the receiver operator characteristic curve than CT, FDG-PET, FDG-PET/CT, or CA-125 for overall detection of recurrent ovarian cancer in a meta- analysis [88]. CT remains the most widely used imaging method for detecting recurrence, and, despite some advantages, the role of MRI in follow-up imaging 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 suspected recurrence of ovarian cancer, MRI is recommended for 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.