title: Treated ovarian cancer: comparison of MR imaging with serum CA-125 level and physical examination--a longitudinal study.
abstract: 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.
authors.affiliation: Department of Diagnostic Radiology, Sharp and Children's MRI Center, Sharp Memorial Hospital, San Diego, CA 92123, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Low
authors.forename: F
authors.initials: F
authors.lastname: Saleh
authors.forename: S Y
authors.initials: SY
authors.lastname: Song
authors.forename: T A
authors.initials: TA
authors.lastname: Shiftan
authors.forename: R M
authors.initials: RM
authors.lastname: Barone
authors.forename: C G
authors.initials: CG
authors.lastname: Lacey
authors.forename: P M
authors.initials: PM
authors.lastname: Goldfarb
mesh_terms: 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
chemical_list: D018394:CA-125 Antigen