Intravenous contrast is preferable for detection and characterization of lesions suspected to represent tumor deposits. MRI without contrast may be considered for staging if contrast cannot be given and may offer improved soft-tissue contrast than noncontrast CT for staging in the pelvis. However, to our knowledge, there are no known studies on the comparative performance of MRI without contrast and CT without contrast for staging. FDG-PET/CT For suspected recurrent ovarian cancer, FDG-PET/CT has recently shown similar or higher accuracy for tumor detection than contrast-enhanced CT or PET alone [10,19,34,89,90], with a sensitivity of 95% to 97% and specificity of 80% to 100% [86,89,91]. The spatial resolution of PET limits sensitivity for subcentimeter metastases, and metabolic activity on or between bowel loops, particularly after surgery when adhesions or Staging and Follow-up of Ovarian Cancer inflammation are present, may be difficult to assess. For such reasons, PET or FDG-PET/CT has not uniformly shown improved sensitivity or specificity of recurrence compared with CT alone [88]. Still, the combined metabolic activity and anatomic localization of FDG-PET/CT have been shown to improve disease detection in small lymph nodes and unresectable sites, which can alter management [87,91]. Notably, the performance of FDG-PET/CT in the literature reflects a predominance of serous papillary carcinomas, and false-negative results have been reported with mucinous adenocarcinomas, and cystic, necrotic, low-grade or small-volume (<7 mm) deposits [82]. Thus, either CT or FDG-PET/CT may be used to evaluate suspected recurrence, and FDG-PET/CT may also be a useful adjunct when CT is indeterminate with persistent clinical concern [92]. Contrast Enema Contrast enema is not routinely used for detecting recurrence of ovarian cancer. IVU IVU is not routinely used for detecting recurrence of ovarian cancer.
Staging and Follow up of Ovarian Cancer. Intravenous contrast is preferable for detection and characterization of lesions suspected to represent tumor deposits. MRI without contrast may be considered for staging if contrast cannot be given and may offer improved soft-tissue contrast than noncontrast CT for staging in the pelvis. However, to our knowledge, there are no known studies on the comparative performance of MRI without contrast and CT without contrast for staging. FDG-PET/CT For suspected recurrent ovarian cancer, FDG-PET/CT has recently shown similar or higher accuracy for tumor detection than contrast-enhanced CT or PET alone [10,19,34,89,90], with a sensitivity of 95% to 97% and specificity of 80% to 100% [86,89,91]. The spatial resolution of PET limits sensitivity for subcentimeter metastases, and metabolic activity on or between bowel loops, particularly after surgery when adhesions or Staging and Follow-up of Ovarian Cancer inflammation are present, may be difficult to assess. For such reasons, PET or FDG-PET/CT has not uniformly shown improved sensitivity or specificity of recurrence compared with CT alone [88]. Still, the combined metabolic activity and anatomic localization of FDG-PET/CT have been shown to improve disease detection in small lymph nodes and unresectable sites, which can alter management [87,91]. Notably, the performance of FDG-PET/CT in the literature reflects a predominance of serous papillary carcinomas, and false-negative results have been reported with mucinous adenocarcinomas, and cystic, necrotic, low-grade or small-volume (<7 mm) deposits [82]. Thus, either CT or FDG-PET/CT may be used to evaluate suspected recurrence, and FDG-PET/CT may also be a useful adjunct when CT is indeterminate with persistent clinical concern [92]. Contrast Enema Contrast enema is not routinely used for detecting recurrence of ovarian cancer. IVU IVU is not routinely used for detecting recurrence of ovarian cancer.