Imaging of ovarian cancer

Cross sectional imaging continues to play an increasingly important role in ovarian cancer diagnosis, staging, and treatment follow-up. Screening for ovarian cancer remains a controversial subject. The combined use of clinical examination, CA-125, and endovaginal ultrasound (US) are being advocated for high risk patients but consensus recommendation for screening awaits further studies. In characterization of an ovarian neoplasm US is indisputedly the primary imaging approach. Only when US is inconclusive are further studies warranted. Magnetic resonance imaging (MRI) is generally preferred to computer tomography (CT). A prospective MRI-CT clinical trial has not been performed as yet. Preoperative staging by imaging is slowly gaining its acceptance. This is mostly due to the awareness of the difficulties and inaccuracy in surgical staging when unsuspected extensive disease is present. Furthermore, in known resectable ovarian cancer, primary chemotherapeutic cytoreduction may be a better treatment option. Accuracy of CT and MRI in staging ovarian cancer is similar, CT, however, is faster, more widely available, and less expensive; these are important attributes that are decisive in this time of health reimbursement constraints.