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 The use of FDG-PET imaging in the primary diagnosis and tissue characterization of ovarian cancer is unsupported to date. Specificity has been reported to be as low as 54%, while sensitivity has been as high as 86% [33,79,80]. Also, false-negative results have been reported with borderline tumors, mucinous tumors, early carcinomas, and other low-grade types of tumors [81,82]. False-positive results have been reported with fibromas, dermoid cysts, hydrosalpinges, and endometriosis [68,80]. However, FDG-PET, especially when combined with CT, is a valuable tool for diagnosing and staging advanced disease [32,34-37,79]. For staging, fusion FDG-PET/CT has higher reported accuracy than either CT or FDG- PET alone in multiple studies [32,35,36,79,83]. Improved detection of peritoneal disease may stem from metabolic activity in small deposits or lymph nodes that may be difficult to identify and characterize with CT alone. Thus, although CT with contrast is the modality of choice for initial staging, PET or FDG-PET/CT may be a useful adjunct test, particularly when CT is indeterminate. Contrast Enema Contrast enema is not routinely used for pretreatment staging of ovarian cancer. An exception may occur when there is concern about the possibility of a colonic primary versus ovarian primary malignancy based on preoperative CT findings, signs, symptoms, and CA-125 and CEA tumor marker ratio. Staging and Follow-up of Ovarian Cancer IVU Intravenous urography (IVU) is not routinely used for pretreatment staging 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 The use of FDG-PET imaging in the primary diagnosis and tissue characterization of ovarian cancer is unsupported to date. Specificity has been reported to be as low as 54%, while sensitivity has been as high as 86% [33,79,80]. Also, false-negative results have been reported with borderline tumors, mucinous tumors, early carcinomas, and other low-grade types of tumors [81,82]. False-positive results have been reported with fibromas, dermoid cysts, hydrosalpinges, and endometriosis [68,80]. However, FDG-PET, especially when combined with CT, is a valuable tool for diagnosing and staging advanced disease [32,34-37,79]. For staging, fusion FDG-PET/CT has higher reported accuracy than either CT or FDG- PET alone in multiple studies [32,35,36,79,83]. Improved detection of peritoneal disease may stem from metabolic activity in small deposits or lymph nodes that may be difficult to identify and characterize with CT alone. Thus, although CT with contrast is the modality of choice for initial staging, PET or FDG-PET/CT may be a useful adjunct test, particularly when CT is indeterminate. Contrast Enema Contrast enema is not routinely used for pretreatment staging of ovarian cancer. An exception may occur when there is concern about the possibility of a colonic primary versus ovarian primary malignancy based on preoperative CT findings, signs, symptoms, and CA-125 and CEA tumor marker ratio. Staging and Follow-up of Ovarian Cancer IVU Intravenous urography (IVU) is not routinely used for pretreatment staging of ovarian cancer.