CT and MRI of ovarian cancer

Among the gynecologic malignancies, ovarian cancer is second most common in incidence. However, unlike the other gynecologic cancers, its mortality has decreased only minimally during the last two decades [1]. Only recently, preliminary studies suggest promising results for ovarian cancer screening using transvaginal ultrasound in combination with serum Ca 125 levels [22,23]. Exploratory laparotomy has been the mainstay in the management of ovarian cancer, as it offers histopathological evaluation as well as cytoreduction. However, it is limited by its inaccuracy with understaging in 30-40% at initial presentation. Cross-sectional imaging contributes valuable information toward preoperative surgical and management planning. The proper surgical approach can be selected, the need for preoperative chemotherapeutic debulking can be assessed, and the surgeon will be forewarned of the need for assistance from a gynecologic oncologic surgeon or gastrointestinal oncologic surgeon if a complicated surgical procedure or bowel resection is indicated. CT is established as the primary imaging modality for characterization of ovarian tumors and ovarian cancer staging, while MR is emerging as a problem-solving modality. MR seems to be superior to CT in lesion characterization, in evaluation of local extent of tumor, and in tumor implants involving the hemidiaphragm and liver surface. The role of spiral CT has yet to be explored.