Abdominal recurrence of ovarian cancer: value of abdominal MR in patients with positive CA125 and negative CT.
OBJECTIVE
To evaluate the role of abdominal MR in the diagnosis of ovarian cancer recurrence in patients with increasing serum Ca-125 levels and negative abdomino-pelvic CT scan.


METHODS
In a period of about 30 months, 22 patients in follow-up for ovarian carcinoma (stages II, III-IV) with increasing levels of Ca-125 and negative abdomino-pelvic CT scan were studied with abdomino-pelvic MR. All patients had a disease-free interval of at least 6 months after cytoreductive surgery and chemotherapy. MR examinations were performed with T1- and T2-weighted SE and FSE sequences in the axial and coronal planes, before and after Gadolinium administration. Tumour recurrence was confirmed at surgery, percutaneous biopsy and by monitoring progression or remission of the disease with clinical examination, Ca-125 serum levels and integrated imaging (CT and MR) during and after medical therapy.


RESULTS
MR imaging demonstrated recurrence of the disease in 16 of the 22 patients, 3 of the remaining 6 patients were true negatives, whereas 3 patients were false negatives (in one case the CT and MR studies missed the peritoneal seeding found at surgery performed 1 month after the MR; in 2 cases both the CT and MR scans became positive for abdominal recurrence after 3 and 4 months respectively). The sensitivity and diagnostic accuracy of MRI were 84% (16/19) whereas specificity was 100% (3/3). The positive predictive value was 100% (16/16) whereas the negative predictive value was 50% (3/6).


CONCLUSIONS
In a selected population of women with increasing serum Ca-125 levels and negative abdominal CT, MR imaging could supply earlier information about the presence and location of recurrences with a high impact on further decisions regarding the choice of therapeutic options (surgical or medical). The limited number of patients requires additional studies to confirm these resuts.
Balestreri
Luca
L
Unità Operativa di Radiologia, Centro di Riferimento Oncologico, IRCCS, Aviano, Italy. lbalestreri@cro.it
Bison
Lorenzo
L
Sorio
Roberto
R
Morra
Aldo
A
Campagnutta
Elio
E
Morassut
Sandro
S
D000008:Abdominal Neoplasms / Q000175:diagnosis* / Q000556:secondary; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D018394:CA-125 Antigen / Q000097:blood*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010051:Ovarian Neoplasms / Q000473:pathology*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor; D018394:CA-125 Antigen