Imaging Modalities for Ovarian Cancer

Initial Evaluation and Staging

The American College of Radiology recommends contrast-enhanced CT of the abdomen and pelvis as the primary imaging modality for ovarian cancer staging, with MRI and PET/CT serving as valuable adjuncts in specific clinical scenarios 1, 2
Transvaginal ultrasound is the first-line imaging modality for evaluating suspected adnexal masses, providing detailed assessment of ovarian morphology and structure 3
For indeterminate adnexal masses on ultrasound, pelvic MRI is the recommended second-line test due to its superior tissue characterization 1, 5

Contrast-enhanced CT of the chest, abdomen, and pelvis is the modality of choice for initial staging of ovarian cancer, providing comprehensive assessment of disease extent, including peritoneal implants, omental involvement, lymphadenopathy, and distant metastases 1, 2, 6
CT findings help determine tumor resectability and guide decisions regarding primary debulking surgery versus neoadjuvant chemotherapy 1, 2

MRI is recommended for patients with borderline tumors or early-stage ovarian cancers with fertility preservation, cases where CT findings are inconclusive, and patients with contraindications to iodinated contrast 6
FDG-PET/CT is valuable for improving accuracy of staging when combined with CT, detecting small peritoneal implants or lymph node metastases, and evaluating recurrent disease 1, 2, 6

CT of the chest, abdomen, and pelvis with intravenous contrast is the primary modality for detecting recurrent disease, while FDG-PET/CT has superior accuracy compared to CT alone, particularly in cases with rising CA-125 levels but negative or equivocal CT findings 6

Ultrasound alone is insufficient for comprehensive staging of ovarian cancer, and CT without intravenous contrast offers limited evaluation of disease extent 1, 2
False-negative results can occur with PET/CT in borderline tumors, mucinous tumors, early carcinomas, and other low-grade types, while false-positive results can occur with fibromas, dermoid cysts, hydrosalpinges, and endometriosis 6

CT abdomen and pelvis should be performed with intravenous contrast administration, thin-slice acquisition, and multiplanar reconstructions 1, 6
MRI pelvis should include T1-weighted sequences with and without fat suppression, T2-weighted sequences, and dynamic contrast-enhanced sequences when not contraindicated 1, 2, 5, 6
PET/CT should be performed after adequate fasting, with standard FDG dose based on patient weight, and with diagnostic quality CT component with intravenous contrast when possible 2, 6