CT and MRI in Advanced Ovarian Cancer: Advances in Imaging Techniques

Ovarian cancer (OC) remains one of the leading causes of gynecologic cancer-related mortality, with most patients presenting with disseminated disease, particularly within the peritoneal cavity. Standard treatment includes cytoreductive surgery, platinum-based chemotherapy, and targeted maintenance approaches depending on the patient's and tumor's genetic profile. Despite treatment advancements, approximately 25% of high-grade serous OC cases relapse within a year despite optimal primary treatment with complete tumor clearance at cytoreduction. Advances in contrast-enhanced CT (CE-CT) and MRI have revolutionized the evaluation and treatment planning of advanced OC. CT remains the gold standard for staging and assessing tumor extent, effectively identifying peritoneal, lymphatic, and distant metastases. However, it is less effective in detecting small-volume peritoneal dissemination. MRI, with superior soft-tissue contrast, complements CT by providing a detailed assessment of peritoneal disease, characterizing sonographically indeterminate adnexal masses. Diffusion-weighted imaging and gadolinium-enhanced MRI have improved the diagnostic sensitivity for peritoneal disease but are unable to predict treatment response, recurrence risk, and prognosis. Radiomics, which extracts quantitative tumor features from imaging data, holds promise for personalizing treatment and identifying patients at risk for early recurrence despite optimal therapy. The integration of CT, MRI, and radiomics could enhance surgical planning and improve long-term survival outcomes in patients with advanced OC.