Treated ovarian cancer: comparison of MR imaging with serum CA-125 level and physical examination--a longitudinal study.
OBJECTIVE
To evaluate whether gadolinium-enhanced magnetic resonance (MR) imaging can demonstrate clinically occult tumors in women with treated ovarian cancer and to compare the diagnostic accuracy of MR imaging, serum CA-125 (ovarian cancer antigen) level, and physical examination.


METHODS
From 1992 to 1997, a longitudinal study comparing MR imaging findings, CA-125 values, and physical examination results with eventual clinical outcome in 69 women with treated ovarian cancer was performed. Tumor presence was determined with surgery, by an elevated CA-125 value, or with follow-up of patients longitudinally to assess for tumor recurrence. Absence of tumor was accepted with a disease-free interval of at least 2 years.


RESULTS
Twenty-three of 39 patients in clinical remission with a normal CA-125 level and physical examination result had subclinical tumor proved at laparotomy or clinical follow-up. Gadolinium-enhanced MR imaging correctly demonstrated residual tumor in 20 of 23 patients. In all 69 patients, MR images had a 91% sensitivity, 87% specificity, 90% accuracy, and 72% negative predictive value and were superior to serum CA-125 level (53%, 94%, 63%, and 38%, respectively) (P < .001) and physical examination (26%, 94%, 43%, and 29%, respectively) (P < .001) in the depiction of residual tumor.


CONCLUSIONS
Gadolinium-enhanced MR imaging is a valuable clinical tool in patients with ovarian cancer. An abnormal MR examination with a normal CA-125 value is a strong indication of residual or recurrent tumor.
Low
R N
RN
Department of Diagnostic Radiology, Sharp and Children's MRI Center, Sharp Memorial Hospital, San Diego, CA 92123, USA.
Saleh
F
F
Song
S Y
SY
Shiftan
T A
TA
Barone
R M
RM
Lacey
C G
CG
Goldfarb
P M
PM
D018394:CA-125 Antigen / Q000097:blood*; D005260:Female; D006801:Humans; D007813:Laparotomy; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis*; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D010808:Physical Examination; D012074:Remission Induction; D012086:Reoperation
D018394:CA-125 Antigen