Elizabeth Sadowski

Imaging in Advanced Epithelial Ovarian Cancer: Assessment of Peritoneal Spread

Radiologists use CT, along with diffusion-weighted MRI and sometimes PET, to assess disease extent, including peritoneal carcinomatosis, in advanced ovarian cancer, preferably applying systematic image interpretation and disease-specific structured reporting to enhance communication and support decision-making.

Distribution of prostate specific membrane antigen (PSMA) on PET-MRI in patients with and without ovarian cancer

Ovarian cancer is the most lethal cancer and future research needs to focus on the early detection and exploration of new therapeutic agents. The objectives of this proof-of-concept study are to assess the feasibility of PSMA 18F-DCFPyl PET/MR imaging for detecting ovarian cancer and to evaluate the PSMA distribution in patients with and without ovarian cancer. This prospective pilot proof-of-concept study in patients with and without ovarian cancers occurred between October 2017 and January 2020. Patients were recruited from gynecologic oncology or hereditary ovarian cancer clinics, and underwent surgical removal of the uterus and ovaries for gynecologic indications. PSMA 18F-DCFPyl PET/MRI was obtained prior to standard of care surgery. Fourteen patients were scanned: four patients with normal ovaries, six patients with benign ovarian lesions, and four patients with malignant ovarian lesions. Tracer uptake in normal ovaries (SUVmax = 2.8 ± 0.4) was greater than blood pool (SUVmax = 1.8 ± 0.5, p < 0.0001). Tracer uptake in benign ovarian lesions (2.2 ± 1.0) did not differ significantly from blood pool (p = 0.331). Tracer uptake in ovarian cancer (SUVmax = 7.8 ± 3.8) was greater than blood pool (p < 0.0001), normal ovaries (p = 0.0014), and benign ovarian lesions (p = 0.005). PET/MR imaging detected PSMA uptake in ovarian cancer, with little to no uptake in benign ovarian findings. These results are encouraging and further studies in a larger patient cohort would be useful to help determine the extent and heterogeneity of PSMA uptake in ovarian cancer patients.

The BUMPy road of peritoneal metastases in ovarian cancer

Ovarian cancer is the most common cause of death due to gynecologic malignancies, with more than 70% of patients presenting with advanced stage disease at the time of diagnosis. The extent and distribution of tumor guide primary treatment selection and clinical management. While primary cytoreductive surgery with complete tumor resection improves survival, patients with extensive peritoneal disease may benefit from neoadjuvant chemotherapy first to reduce tumor burden followed by interval cytoreductive surgery. Imaging plays an essential role in triaging patients including selecting patients who may benefit from neoadjuvant chemotherapy before cytoreductive surgery. Interestingly, there are no universally established criteria to predict resectability and local practices depend on local guidelines and surgeon preferences. Nevertheless, certain anatomical tumor locations are known to be difficult to resect and are associated with suboptimal cytoreduction or require special surgical considerations. This review discusses the recent advances in the initial management of patients with ovarian cancer, a practical approach to the assessment and communication of peritoneal metastases locations on CT and MRI. It also explores recent advances in genomics profiling and radiomics that may influence the initial management of these patients.

Incidental Adnexal Lesions: CT Diagnosis and Interreader Agreement

Even among nine expert readers, CT diagnosis was not reproducible and was frequently incorrect for most adnexal lesion types, excluding dermoids, malignant ovarian lesions with metastases, and simple cysts.

The Ovarian-Adnexal Reporting and Data System (O-RADS) US Score Effect on Surgical Resection Rate

Among ovarian and adnexal lesions surgically removed before 2015, a large proportion were retrospectively assessed as Ovarian-Adnexal Imaging Reporting and Data System US 2, which may have allowed for more conservative management in these patients.

The Roles of Ovarian-Adnexal Reporting and Data System US and Ovarian-Adnexal Reporting and Data System MRI in the Evaluation of Adnexal Lesions

Ovarian-Adnexal Reporting and Data System US and MRI provide evidence-based lexicons and risk assessment systems that can accurately diagnose most adnexal lesions as benign and effectively risk stratify those that are suspicious for malignancy.