Imaging is an integral part of ovarian cancer detection, diagnosis, management, and treatment follow-up. A number of imaging modalities are available, and a variety of new techniques, especially molecular imaging approaches, are being developed. Each imaging modality has its unique advantages and limitations; therefore, evidence-based use of imaging is essential for achieving the greatest possible benefit without over- or underuse of specific modalities. Since imaging is a continuously advancing field, it is important for clinicians to keep abreast of new developments and revise aspects of their clinical practice in line with these developments.
Briefly, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are established imaging modalities in the evaluation of ovarian cancer, and positron emission tomography (PET) is an emerging modality. In terms of screening for ovarian cancer, established clinical guidelines are available to guide the selection of appropriate modalities. Transvaginal ultrasound has consistently been the most promising imaging modality for routine screening for ovarian cancer among the imaging modalities that have been tested. When it comes to lesion detection and characterization, for patients presenting with pertinent symptoms, the imaging workup generally includes an ultrasound or contrast-enhanced CT of the abdomen and pelvis in addition to a complete physical examination and appropriate laboratory tests.1 MRI of the pelvis or abdomen may be used for problem solving when imaging findings on ultrasound are equivocal, or in patients who have contraindications to iodinated CT contrast. Chest x-ray is typically obtained as part of the overall evaluation before surgical staging. Other diagnostic studies, such as gastrointestinal tract evaluation, are not routinely recommended, unless indicated in specific clinical situations.
After the completion of primary surgery and chemotherapy in patients with ovarian cancer, imaging plays an important role in follow-up. The most frequently used imaging modalities include CT of the abdomen and pelvis, PET, and PET/CT. Again, MRI is reserved as a problem-solving tool or is used for patients with contraindications to CT scanning. For patients with borderline epithelial ovarian cancer (also known as epithelial ovarian cancer of low malignant potential [LMP]) who chose fertility-sparing surgery, close monitoring with ultrasound examinations should be considered.
This chapter discusses the roles of different modalities, including ultrasound, CT, MRI, and PET in ovarian cancer screening, detection, and characterization, as well as pretreatment staging and post-treatment follow-up.
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