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Treated Ovarian Cancer: MR Imaging, Laparotomy Reassessment, and Serum CA-125 Values Compared with Clinical Outcome at 1 Year¹

¹ From the Departments of Diagnostic Radiology (R.N.L.), Gynecologic Oncology (B.D.), Surgical Oncology (R.M.B.), and Medical Oncology (F.S., S.Y.T.S.), Sharp Memorial Hospital, 7901 Frost St, San Diego, CA 92123. Received March 7, 2004; revision requested May 19; revision received June 21; accepted July 27. Address correspondence to R.N.L. (e-mail: rlow@ucsd.edu).

View larger version (137K): [in a new window]   Figure 1a. MR images of 69-year-old woman with treated stage III ovarian cancer whose disease was in clinical remission and who had serum CA-125 value of 22 U/mL. (a) Transverse and (b) coronal gadolinium-enhanced spoiled gradient-echo MR images (165/2.1, 70° flip angle) show a 3-cm mass (arrow) in anterior middle portion of abdomen, which represents residual tumor. Findings were confirmed at laparotomy.

View larger version (155K): [in a new window]   Figure 1b. MR images of 69-year-old woman with treated stage III ovarian cancer whose disease was in clinical remission and who had serum CA-125 value of 22 U/mL. (a) Transverse and (b) coronal gadolinium-enhanced spoiled gradient-echo MR images (165/2.1, 70° flip angle) show a 3-cm mass (arrow) in anterior middle portion of abdomen, which represents residual tumor. Findings were confirmed at laparotomy.

View larger version (105K): [in a new window]   Figure 2. Transverse gadolinium-enhanced spoiled gradient-echo MR image (165/2.1, 70° flip angle) of 55-year-old woman with treated stage III ovarian cancer and serum CA-125 value of 89 U/mL. Image through upper portion of abdomen shows enhancing perisplenic peritoneal tumor (arrowheads). A thin rim of subphrenic tumor (arrows) on the right side of the abdomen is also present. No tumor was found at laparotomy. On the basis of MR findings, fluid from left portion of upper abdomen was aspirated percutaneously. Results of cytologic evaluation confirmed residual tumor. Discussion with patient’s surgical oncologist confirmed that fluid aspiration site agreed with suspected tumor site on MR images.

View larger version (169K): [in a new window]   Figure 3a. MR images of 51-year-old woman with treated stage III ovarian cancer and serum CA-125 value of 100 U/mL. Laparotomy showed no evidence of tumor. (a) Transverse fast spin-echo T2-weighted MR image (2500/94, one signal acquired, and 90° flip angle) with fat suppression through upper portion of abdomen shows small perisplenic tumor (arrows). (b) Transverse gadolinium-enhanced spoiled gradient-echo MR image (165/2.1, 70° flip angle) shows small enhancing perisplenic metastases (arrows). Within 4 months, patient developed clear evidence of progressive tumor, with serum CA-125 value of 600 U/mL. Results of percutaneous CT-guided biopsy confirmed residual ovarian cancer, and follow-up MR examinations showed progressive disseminated tumor.

View larger version (174K): [in a new window]   Figure 3b. MR images of 51-year-old woman with treated stage III ovarian cancer and serum CA-125 value of 100 U/mL. Laparotomy showed no evidence of tumor. (a) Transverse fast spin-echo T2-weighted MR image (2500/94, one signal acquired, and 90° flip angle) with fat suppression through upper portion of abdomen shows small perisplenic tumor (arrows). (b) Transverse gadolinium-enhanced spoiled gradient-echo MR image (165/2.1, 70° flip angle) shows small enhancing perisplenic metastases (arrows). Within 4 months, patient developed clear evidence of progressive tumor, with serum CA-125 value of 600 U/mL. Results of percutaneous CT-guided biopsy confirmed residual ovarian cancer, and follow-up MR examinations showed progressive disseminated tumor.

View larger version (147K): [in a new window]   Figure 4. Transverse gadolinium-enhanced spoiled gradient-echo MR image (165/2.1, 70° flip angle) of 61-year-old woman with treated ovarian cancer, acute bowel obstruction, and normal serum CA-125 value. Image shows 2-cm enhancing soft-tissue mass (arrow) at point of bowel obstruction. Surgical and histopathologic findings demonstrate fibrotic mass and adhesions without evidence of tumor. MR images were interpreted as false-positive for tumor recurrence.

View larger version (40K): [in a new window]   Figure 5. Graph shows combined performance of MR imaging, laparotomy (Lap), and serum CA-125 values in predicting tumor presence or absence in women with treated ovarian cancer. Laparotomy results that were positive for tumor (Lap+) and elevated CA-125 values (CA 125+) are indicated. Graph shows percentages of 76 patients in whom each test or combination of tests was correct in predicting presence or absence of residual tumor.