Imaging of ovarian cancer

Prognostic value of preoperative metabolic tumor volume and total lesion glycolysis in patients with epithelial ovarian cancer

PURPOSE

Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are measures of metabolic activity of tumors determined by fluorine-18 fluorodeoxyglucose ([(18)F]FDG) uptake on PET/CT images. The purpose of this study was to investigate the relationship between functional tumor parameters (MTV and TLG) and clinical outcomes in patients with epithelial ovarian cancer (EOC).

METHODS

Fifty-five patients with EOC who had undergone [(18)F]FDG PET/CT before surgical staging were included in this retrospectively study. For each patient, we determined the highest (SUV(max) and SUV(avg)), the cumulative TLG, and the sum of all MTV, and compared their predictive value of recurrence and the effects of pretreatment functional tumor activity on progression-free interval (PFI).

RESULTS

The median duration of PFI was 11 (range 3-43) months, and 20 patients (36.4%) experienced recurrence. Poor outcome was associated with higher values for both the MTV (P = 0.022, hazard ratio 5.571, 95% confidence interval 1.279-24.272) and the TLG (P = 0.037, hazard ratio 2.967, 95% confidence interval 1.065-8.265). The Kaplan-Meier survival graphs showed a significant difference in PFI between the groups categorized by MTV and TLG, respectively (P = 0.01 for MTV, P = 0.0287 for TLG, log rank test).

CONCLUSIONS

Pretreatment metabolic parameters such as MTV and TLG showed statistically significant association with recurrence in patients with EOC. These values can be useful quantitative criteria for disease prognostication in patients with EOC before treatment.

Diagnosis and staging of primary ovarian cancer: correlation between PET/CT, Doppler US, and CT or MRI

PURPOSE

To compare the diagnostic accuracy of positron emission tomography/computed tomography (PET/CT), pelvic Doppler ultrasonography (US), abdomino-pelvic computed tomography (CT), and pelvic magnetic resonance imaging (MRI) for detection of ovarian cancer and to assess the role of PET/CT in evaluating the dissemination of ovarian cancer.

PATIENTS AND METHODS

One hundred thirty-three women suspected to have ovarian cancer were enrolled in a prospective study before surgery between March 2005 and August 2007. The accuracy of each modality in detection of malignancy was estimated by computing the relevant areas under a receiver operating characteristics curve. Histopathologic results served as the reference standard.

RESULTS

Histopathology showed benign tumors in 25 patients, borderline tumors in 13 patients, and malignant tumors in 95 patients. In distinguishing malignant/borderline from benign ovarian tumors, the accuracy of PET/CT (0.921) was higher than that of pelvis US (0.830) and abdomino-pelvic CT or pelvis MRI (0.749; P=0.013). Radiologic staging by PET/CT was concordant with surgical staging in 78% of patient and PET/CT revealed 15 (15.8%) unpredicted extra-abdominal lymph node metastasis in 95 patients with ovarian cancer. In addition, PET/CT detected new, unexpected co-existing malignant tumors in five (3.8%) cases including two thyroid tumors, two breast tumors, and one pancreatic neuroendocrine cancer.

CONCLUSION

PET/CT is superior to pelvis US, abdomino-pelvic CT, and pelvic MRI for diagnosis of malignant ovarian tumors and is useful in revealing metastatic ovarian cancer and co-existing malignant tumors. Therefore, we suggest that PET/CT could be used during pre-operative evaluation of patients suspected to have ovarian cancer.

Novel nanomedicine-based MRI contrast agents for gynecological malignancies

Gynecological cancers result in significant morbidity and mortality in women despite advances in treatment and diagnosis. This is due to detection of the disease in the late stages following metastatic spread in which treatment options become limited and may not result in positive outcomes. In addition, traditional contrast agents are not very effective in detecting primary metastatic tumors and cells due to a lack of specificity and sensitivity of the diagnostic tools, which limits their effectiveness. Recently, the field of nanomedicine-based contrast agents offers a great opportunity to develop highly sophisticated devices that can overcome many traditional hurdles of contrast agents including solubility, cell-specific targeting, toxicities, and immunological responses. These nanomedicine-based contrast agents including liposomes, micelles, dendrimers, multifunctional magnetic polymeric nanohybrids, fullerenes, and nanotubes represent improvements over their traditional counterparts, which can significantly advance the field of molecular imaging.

The accurate staging of ovarian cancer using 3T magnetic resonance imaging--a realistic option

OBJECTIVES

The aim of the study was to determine whether staging primary ovarian cancer using 3.0 Tesla (3T) magnetic resonance imaging (MRI) is comparable to surgical staging of the disease.

DESIGN

A retrospective study consisting of a search of the pathology database to identify women with ovarian pathology from May 2004 to January 2007.

SETTING

All women treated for suspected ovarian cancer in our cancer centre region.

SAMPLE

All women suspected of ovarian pathology who underwent 3T MRI prior to primary surgical intervention between May 2004 and January 2007.

METHODS

All women found to have ovarian pathology, both benign and malignant, were then cross checked with the magnetic resonance (MR) database to identify those who had undergone 3T MRI prior to surgery. The resulting group of women underwent comparison of the MR, surgical and histopathological findings for each individual including diagnosis of benign or malignant disease and International Federation of Gynecology and Obstetrics (FIGO) staging where appropriate.

MAIN OUTCOME MEASURES

Comparisons were made between the staging accuracy of 3T MRI and surgical staging compared with histopathological findings and FIGO stage using weighted kappa. Sensitivity, specificity and accuracy were calculated for diagnosing malignant ovarian disease with 3T MRI.

RESULTS

A total of 191 women identified as having ovarian pathology underwent imaging with 3T MR and primary surgical intervention. In 19 of these women, the ovarian disease was an incidental finding. The group for which staging methods were compared consisted of 77 women of primary ovarian malignancy (20 of whom had borderline tumours). 3T MRI was able to detect ovarian malignancy with a sensitivity of 92% and a specificity of 76%. The overall accuracy in detecting malignancy with 3T MRI was 84%, with a positive predictive value of 80% and negative predictive value of 90%. Statistical analysis of the two methods of staging using weighted kappa, gave a K value of 0.926 (SE +/-0.121) for surgical staging and 0.866 (SE +/-0.119) for MR staging. A further analysis of the staging data for ovarian cancers alone, excluding borderline tumours resulted in a K value of 0.931 (SE +/-0.136) for histopathological staging versus MR staging and 0.958 (+/-0.140) for histopathological stage versus surgical staging.

CONCLUSION

Our study has shown that MRI can achieve staging of ovarian cancer comparable with the accuracy seen with surgical staging. No previous studies comparing different modalities have used the higher field strength 3T MRI. In addition, all other studies comparing radiological assessment of ovarian cancer have grouped the stages into I, II, III and IV rather than the more clinically appropriate a, b and c subgroups.

MR Imaging of Gynecologic Diseases at 3T

MR imaging using anatomic, chemical, and functional information offers huge potential for the management of the gynecologic patient. By differentiating benign from malignant disease with very high specificity, it can aid the selection of patients requiring further treatment and determine the level of urgency. Staging accuracy, which equals that obtained at laparotomy, allows appropriate clinical expertise to be organized before surgery or the deferment of surgery until later in the treatment pathway and is a cost-effective use of resources. This article compares and contrasts MR imaging of gynecologic conditions at 1.5 and 3T and defines a role for high field imaging for these clinical conditions.

Role of [18F]FDG PET/CT in the assessment of suspected recurrent ovarian cancer: correlation with clinical or histological findings

PURPOSE

To evaluate the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) for depiction of suspected recurrent ovarian carcinoma after treatment, with use of clinical or histological findings as the reference standard.

METHODS

Seventy-seven women (median age, 51 years) with ovarian carcinoma treated with primary cytoreductive surgery followed by platinum-based combination chemotherapy were included, and [18F]fluorodeoxyglucose (FDG) PET/CT was performed for suspected recurrence. In all patients, imaging findings were compared with results of histological examination after surgical exploration or clinical follow-up to determine the diagnostic accuracy of PET/CT in the evaluation of disease status. Fisher's exact test was used to measure the ability of PET/CT to predict recurrent lesions.

RESULTS

Forty-five (58.4%) of the 77 patients had documented recurrence during surgical exploration or clinical follow-up, while 32 (41.6%) had no evidence of recurrent tumour. Of the 45 patients with recurrent disease, 27 (60%) were confirmed to have recurrence by surgical biopsy. A correlation was found between PET/CT and histological or clinical analyses (kappa = 0.894). The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET/CT were 93.3%, 96.9%, 94.8%, 97.7% and 91.2%, respectively. PET/CT modified the diagnostic or treatment plan in 19 (24.7%) patients, by leading to the use of previously unplanned therapeutic procedures in 11 (57.9%) patients and the avoidance of previously planned diagnostic procedures in eight (42.1%) patients.

CONCLUSION

Integrated FDG PET/CT is a sensitive post-therapy surveillance modality for the detection of recurrent ovarian cancer; it aids decisions on treatment plans and may ultimately have a favourable impact on prognosis.

18F-FDG PET/CT in the evaluation of recurrent ovarian cancer: a prospective study on forty-one patients

AIM

Many patients with ovarian cancer are at high risk of recurrence especially in the 2 years following first-line therapy. CA125 serum levels measurement associated to computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI) are currently used during follow-up to detect recurrent disease. Unfortunately, in a relevant percentage of cases all of these traditional imaging techniques provide a significant number of doubtful/equivocal results or turn out negative even in presence of elevated Ca125 levels. Aim of our study was to evaluate sensitivity, specificity and accuracy of (18)F-FDG PET/CT in a group of patients with suspicion of ovarian cancer recurrence.

METHODS

We prospectively evaluated 41 patients with a mean age of 59.4 years who had been previously treated for ovarian cancer with surgery and radio-chemotherapy or radio-chemotherapy alone. Following the performance of traditional radiologic imaging (US, CT, MRI) and Ca125 measurement, all patients underwent additional (18)F-FDG PET/CT. PET/CT results were compared with histologic findings or clinical, laboratory and repeated traditional imaging techniques during subsequent follow-up data.

RESULTS

Of 41 patients 32 had a positive PET-CT (30 true positive, two false positive) whereas nine a negative PET/CT (five true negative, four false negative). Overall, in our experience (18)F-FDG PET/CT provided a good sensitivity (88.2%), specificity (71.4%) and accuracy (85.4%), superior to that reported in literature for traditional radiologic imaging.

CONCLUSIONS

It can be concluded that (18)F-FDG PET/CT appears to be a useful and accurate tool in disclosing early recurrent ovarian cancer.

Role of CT and MR imaging in predicting optimal cytoreduction of newly diagnosed primary epithelial ovarian cancer

OBJECTIVE

To determine the relative accuracy of CT or MR imaging in the detection of inoperable tumor sites prior to cytoreductive surgery in a large series of patients with newly diagnosed primary epithelial ovarian cancer.

METHODS

One hundred thirty-seven women with newly diagnosed primary epithelial ovarian cancer underwent CT (n = 91) or MR imaging (n = 46) prior to cytoreductive surgery. The following imaging criteria were used to identify inoperable tumor sites: (1) peritoneal implants greater than 2 cm in maximum diameter in the porta hepatis, intersegmental fissure, gall bladder fossa, subphrenic space, gastrohepatic ligament, gastrosplenic ligament, lesser sac, or root of the small bowel mesentery; (2) retroperitoneal adenopathy greater than 2 cm in maximum diameter above the renal hila; (3) hepatic metastases or abdominal wall invasion. Imaging results were compared with operability at surgery.

RESULTS

Cytoreductive surgery was suboptimal in 21 of the 137 (15%) patients. Sixteen of these patients had inoperable tumor on preoperative imaging, while one additional patient had apparently inoperable tumor on imaging but was optimally debulked at surgery. The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative imaging for the prediction of suboptimal debulking were 76% (16/21), 99% (115/116), 94% (16/17), and 96% (115/120), respectively. CT and MR imaging were equally effective (P = 1.0) in the detection of inoperable tumor.

CONCLUSION

Preoperative CT and MR imaging are equally accurate in the detection of inoperable tumor and the prediction of suboptimal debulking in newly diagnosed epithelial ovarian cancer. This suggests imaging may help select patients who might be more appropriately managed by neoadjuvant chemotherapy.

PET-CT in recurrent ovarian cancer: initial observations

Noninvasive diagnosis of early recurrence of ovarian cancer is challenging due to the small size of peritoneal metastases. Small-volume disease may not be evident at anatomic imaging in patients with elevated serum tumor markers. Functional imaging in the form of positron emission tomography (PET) can help identify patients with recurrent tumor. However, lesion localization for possible surgical treatment is difficult with PET alone. Combined functional-anatomic imaging with fused PET and computed tomographic (CT) scans is feasible and may improve disease detection by increasing radiologic sensitivity and specificity. PET and PET-CT have a potential role in evaluating patients for recurrent ovarian cancer, particularly those with negative CT or magnetic resonance imaging findings and rising tumor marker levels. Fused PET-CT scans obtained with combined scanners can help localize pathologic activity and differentiate this activity from physiologic radiotracer uptake. Combined functional-anatomic imaging can also increase diagnostic confidence at CT. Further study is needed to determine the possible benefits of lesion conspicuity at PET and anatomic localization at CT on fused PET-CT scans.

Ovarian cancer: the clinical role of US, CT, and MRI

This article presents an overview of ovarian cancer, which addresses the clinical roles of imaging studies, including US, CT, and MR imaging in the course of diagnosis and treatment of this important disease. US is the modality of choice in the evaluation of patients with suspected adnexal masses. Although its accuracy is not sufficient to avert surgery, morphological analysis of adnexal masses with US helps narrow the differential diagnosis, determining the degree of suspicion for malignancy, usually in concert with a serum CA-125 level. Combined morphological and vascular imaging obtained by US appear to further improve the preoperative assessment of adnexal masses. For uncertain or problematic cases, MR imaging helps to distinguish benign from malignant, with an overall accuracy for the diagnosis of malignancy of 93%. The accuracy of MR imaging in the confident diagnosis of mature cystic teratoma, endometrial cysts, and leiomayomas is very high. CT is not indicated for differential diagnosis of adnexal masses because of poor soft tissue discrimination, except for fatty tissue and for calcification, and the disadvantages of irradiation. In the staging of ovarian cancer, CT, US, and MR imaging all have a similarly high accuracy. Although it is difficult to suggest a simple algorithm for evaluating the state of women with adnexal masses, the correct preoperative diagnosis and staging of ovarian cancer with the use of any of these imaging studies will lead to an appropriate referral to a specialist in gynecologic oncology and offer a significant survival advantage for patients with ovarian cancer.

Multidetector CT of peritoneal carcinomatosis from ovarian cancer

Ovarian cancer is usually in an advanced stage at diagnosis due to the presence of peritoneal carcinomatosis, which develops as a result of peritoneal fluid circulation. Tumor implants of varying size can occur anywhere from the diaphragm through the pelvis. Computed tomography (CT) can be used to detect these metastatic lesions, which can be miliary or large and appear as soft-tissue or low-attenuation masses. Recent advances in CT technology have increased the flexibility of image acquisition, thereby allowing the use of thin sections and multiplanar reformatting. With multidetector CT, thin-section images of the abdomen and pelvis can be obtained to assess for subcentimeter implants and to create three-dimensional images with reduced artifact. Multiplanar reformatting can be used to confirm the presence of implants. Structures such as the diaphragm, paracolic gutters, bowel, and cul-de-sac can be evaluated in multiple planes for surface nodularity and small implants. Interactive multiplanar review of the abdomen and pelvis has the potential to improve detection of peritoneal metastases at CT.

Usefulness of FDG PET for assessment of early recurrent epithelial ovarian cancer

OBJECTIVE

The purpose of our study was to evaluate the diagnostic accuracy of FDG positron emission tomography (PET) in comparison with CT in detecting recurrent ovarian carcinoma and its ability to reveal small tumor recurrence.

MATERIALS AND METHODS

We reviewed the records of 31 consecutive patients with pathologically proven epithelial carcinoma who underwent FDG PET 1 month before second-look surgery to assess recurrent tumor. Of these 31 patients, 21 patients also underwent CT 1 month before second-look surgery. The diagnostic accuracies of FDG PET (n = 31), CT (n = 21), and combined FDG PET and CT (n = 21) in detecting recurrent tumor were calculated and compared with each other using the Bennett's test in 21 patients who underwent both imaging studies. Detection rates of individual tumors relative to their sizes were compared between FDG PET and CT using the McNemar test.

RESULTS

The sensitivity, specificity, and accuracy of FDG PET, CT, and combined FDG PET and CT for revealing recurrent ovarian cancer were 45.3%, 99.7%, 91.0%; 54.5%, 99.6%, 91.7%; 58.2%, 99.6%, 92.4%, respectively. We found no statistically significant difference in the diagnostic accuracy of FDG PET, CT, and combined FDG PET and CT (chi(2) < 5.991). Detection rates of tumor nodules found on CT were significantly greater than those on FDG PET when nodule size was 0.3-0.7 cm (p < 0.05).

CONCLUSION

FDG PET did not improve the overall diagnostic accuracy in detecting recurrent ovarian carcinoma compared with CT. Rather, FDG PET was inferior to CT in its ability to reveal small-tumor recurrence.

Staging ovarian cancer: role of imaging

Ovarian cancer is relatively common, and often presents at an advanced stage with widespread intraperitoneal metastases. The constellation of complex pelvic masses, ascites, omental cake, and other peritoneal implants is virtually diagnostic. All patients are potential surgical candidates, since suspected early stage disease is treated by a comprehensive staging laparotomy including total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. Operable advanced disease is treated by surgical debulking and adjuvant combination chemotherapy. The role of imaging is to detect and characterize adnexal masses as likely malignant, recognize unusual findings that may suggest atypical pathology, demonstrate metastases in order to prevent under-staging, and detect specific sites of disease that may be unresectable. These aims are directly related to clinical management; characterization of an adnexal mass as malignant guides appropriate surgical referral, recognition of atypical pathology such as malignant granulosa cell tumor in a young woman may be an indication for fertility-preserving surgery. Demonstration of metastatic site-assists surgical planning, and detection of unresectable disease may be an indication for neoadjuvant (ie, preoperative) chemotherapy with interval debulking rather than primary debulking with adjuvan (postoperative) chemotherapy.

Detection and characterization of adnexal masses

The main challenge to the radiologist is to differentiate benign from malignant adnexal masses. Both US and MRI perform well for prediction of benignity. There is less specificity for diagnosis of malignancy but features, such as papillary projections, thickened septations, and internal vascularity within nodules, aid in this differentiation. The combination of morphology and Doppler characteristics provide the most accurate US diagnosis. For sonographically indeterminate masses, MRI is useful for additional lesion characterization. Analysis of T1- and T2-weighted signal intensities for benign-appearing lesions with the addition of fat saturation for high signal on T1-weighted sequences may lead to an exact diagnosis or a narrow differential. For cases considered suspicious by TVUS, more specific diagnosis by MRI may obviate the need for surgery or otherwise change management by identification of benign etiology.

Staging of advanced ovarian cancer: comparison of imaging modalities--report from the Radiological Diagnostic Oncology Group

PURPOSE

To compare ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT) for diagnosing and staging advanced ovarian cancer.

MATERIALS AND METHODS

US, CT, and MR imaging were performed in 280 patients. Images were read by three radiologists from each of the five hospitals. Image analysis included determination of malignancy within the peritoneum (11 sites), lymph nodes (10 sites), and hepatic parenchyma. The standard of reference was based on surgical and histopathologic findings. Statistical methods used were receiver operating characteristic (ROC) curve analysis, pairwise comparison of areas under the ROC curves (A(z)), analysis of sensitivity and specificity pairs, and assessment of agreement between the degree of suspicion and standard of reference.

RESULTS

There were 118 patients with malignant tumors; 73 (62%) had stage III or IV disease. Metastases were found in the peritoneum in 70 (59%), nodes in 20 (17%), and liver in seven (6%) cases. In the peritoneum, MR imaging and CT (A(z) = 0.96 for both) were more accurate than US (A(z) = 0.86), especially in the subdiaphragmatic spaces and hepatic surfaces. MR imaging and CT were more sensitive than US (95%, 92%, and 69%, respectively) for peritoneal metastases. MR imaging was more accurate than CT for detection of lymph node metastases (A(z) = 0.76 vs 0.57, P =.04). In the liver, the A(z) values for the three modalities were 0.77-0.94.

CONCLUSION

CT and MR imaging are equally accurate, and either modality can be used to stage advanced ovarian cancer.

Classification of asymptomatic adnexal masses by ultrasound, magnetic resonance imaging, and positron emission tomography

OBJECTIVE

The purpose of this study was to determine the diagnostic accuracy of sonography versus magnetic resonance imaging (MRI) and positron emission tomography (PET) in the characterization of adnexal masses.

METHODS

One hundred and one patients with asymptomatic adnexal masses, which were scheduled for laparoscopy, underwent preoperative transvaginal ultrasound, MRI, and 2-[(18)F]fluoro-2-deoxy-d-glucose PET. Two different sonomorphological scoring systems were used to distinguish malignant from benign lesions. In addition, transvaginal Doppler flow velocimetry was performed and the resistance index (RI) of ovarian blood vessels was calculated. RI values below 0.45 were considered to indicate malignancy. MRI was evaluated on the basis of signal intensity and morphologic features such as wall thickness, septations, fluid or solid components, and vascularity. PET imaging was used to determine 2-[(18)F]fluoro-2-deoxy-D-glucose uptake. Malignancy was suspected if radiotracer uptake equaled or exceeded that of the liver. Based on histologic findings, sensitivity, specificity, positive and negative predictive values, and accuracy were first calculated independently for each imaging technique. Finally, a second session resulted in a consensus diagnosis being made based on the findings of all three modalities.

RESULTS

Sonographic evaluation of adnexal masses resulted in correct classification of 11 of 12 ovarian malignancies (sensitivity 92%) but with a specificity of only 60%. With MRI and PET, specificities improved to 84 and 80% respectively, but sensitivities decreased. When all imaging modalities were combined, sensitivity and specificity were 92 and 85%, respectively, and accuracy was 86%.

CONCLUSION

Combination of ultrasound with MRI and PET may improve accuracy in differentiation of benign from malignant ovarian lesions. However, negative MRI or PET results do not rule out early-stage ovarian cancer or borderline malignancies.

CT of epithelial ovarian tumors

Ovarian cancer is the second most common gynecologic malignancy in the United States and causes more deaths than any other cancer of the female reproductive system. Approximately two-thirds of patients have tumors that have spread beyond the pelvis at the time of diagnosis. Ovarian tumors arise from the surface epithelium or mesothelium, germ cells, or the gonadal stroma. Epithelial ovarian tumors include serous, mucinous, endometrioid, clear cell, and undifferentiated tumors. In general, the likelihood of malignancy increases with increasing solid-tissue elements and thicker septa. Surgery is central to the management of ovarian cancer. At the initial exploratory laparotomy, surgicopathologic staging and debulking of the tumor are undertaken. Patients with advanced cancer frequently undergo second-look surgery after chemotherapy to detect any residual disease. CT can provide staging information for preoperative planning and determination of surgical resectability, demonstrate tumor response to therapy, and allow detection of persistent or recurrent disease. However, a major limitation of CT is the lack of sensitivity for detection of small tumor implants, especially on the small intestine or mesentery. Dedicated CT of the pelvis is best performed with spiral CT. Ovarian carcinoma can spread by means of intraperitoneal implantation, lymphatic invasion, and hematogenous dissemination.

Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis--report of the Radiology Diagnostic Oncology Group

PURPOSE

To determine the optimal imaging modality for diagnosis and staging of ovarian cancer.

MATERIALS AND METHODS

Two hundred eighty women suspected to have ovarian cancer were enrolled in a prospective study before surgery. Doppler ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging were used to evaluate the mass; conventional US, CT, and MR imaging were used to stage spread.

RESULTS

All three modalities had high accuracy (0.91) for the overall diagnosis of malignancy. In the ovaries, the accuracy of MR imaging (0.91) was higher than that of CT and significantly higher than that of Doppler US (0.78). In the extraovarian pelvis and in the abdomen, conventional US, CT, and MR imaging had similar accuracies (0.87-0.95). In differentiation of disease confined to the pelvis from abdominal spread, the specificity of conventional US (96%) was higher than that of CT and significantly higher than that of MR imaging (88%), whereas the sensitivities of MR imaging (98%) and CT (92%) were significantly higher than that of conventional US (75%).

CONCLUSION

MR imaging is superior to Doppler US and CT in diagnosis of malignant ovarian masses. There is little variation among conventional US, CT, and MR imaging as regards staging.