A standard technique is employed for examination of the abdomen and pelvis (see Chapter 2). In addition, fat suppressed T1-weighted images post Gd-chelate aid in characterisation of the internal architecture of cystic ovarian lesions and improve detection of peritoneal and omental implants.
The use of a negative bowel contrast agent such as 2% barium allows distension of bowel and improves detection of enhancing serosal deposits. An anti-peristaltic agent such as glucagon or hyoscine butylbromide aids in detection of serosal and peritoneal deposits by reducing bowel movement artifact.
If available, breath-hold axial fast multiplanar Spoiled Gradient Recalled Echo images with fat suppression both before and after Gdchelate should replace the T1 images and are superior due to reduced movement artifact and reduced scan times.
Ovarian cancer staging is usually performed surgically and neither MR imaging nor CT have a role in most instances. CT is employed in the evaluation of post-operative tumour residuum prior to chemotherapy and in the assessment of tumour response to chemotherapy.
MRI may be useful in assessment and pre-operative planning in advanced ovarian cancer where pelvic spread is suspected or in cases of localised pelvic recurrence. It is the optimal method for evaluating spread to involve the uterus, bladder, rectum or pelvic sidewall and in determining if tumours can be optimally debulked.
MRI is indicated for treatment planning in patients who are allergic to iodinated contrast media, pregnant or have an inconclusive CT examination. It may also be indicated if the CT examination is negative but there has been a significant rise in the CA-125.
Other roles for MRI include the further characterisation of an ovarian mass where other imaging investigations have been nondiagnostic or equivocal.
Certain features suggest malignancy in ovarian masses. Solid, non-fatty, non-fibrous tissue is the most powerful predictor of malignancy
Table 6.4. FIGO and TNM classification of ovarian carcinoma
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