Prospective evaluation of contrast-enhanced MRI in the depiction of peritoneal spread in primary or recurrent ovarian cancer

The purpose of this study was to assess the accuracy of MRI in the staging of intra-abdominal tumor seeding of ovarian carcinoma. Fifty-seven patients with suspected primary or recurrent ovarian carcinoma were included in this study. All patients received laparotomy within 8 weeks after MRI. The MRI protocol included fat-saturated T1-weighted spin-echo (SE) sequences pre- and post i.v. application of gadopentetate dimeglumine. The criteria for tumor manifestation was contrast enhancement of intra-abdominal soft tissue lesions or peritoneum. The image review was performed by a blinded radiologist, a specialist in gynecological and abdominal MR imaging. Results were compared with findings during laparotomy. Sensitivity, specificity, positive and negative predictive values, and corresponding 95% confidence intervals were calculated for single intra-abdominal locations and for groups of locations defined according to surgical strategies for intra-abdominal cytoreduction. Laparotomy and histopathology confirmed 251 abdominal tumor locations. Sensitivity was high in lower pelvis locations (73-83%) except for ureter or bladder infiltration (40%). Bowel or mesentery locations displayed sensitivity values from 73 to 77%. Sensitivity was very low for pelvic lymph nodes (28%), greater omentum (38%), and lesser sac (43%). Magnetic resonance imaging based on contrast-enhanced fat-saturated T1 SE sequences improves planning of cytoreduction preceding chemotherapy in advanced primary or relapsed ovarian carcinoma.