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Staging of Advanced Ovarian Cancer: Comparison of Imaging Modalities-Report from the Radiological Diagnostic Oncology Group¹

¹ From the Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (C.M.C.T., S.G.S., D.L.B., B.J.M.); the Department of Health Care Policy, Harvard Medical School, Boston, Mass (K.H.Z., B.J.M.); and the Department of Radiology, Jefferson Medical College and Thomas Jefferson University Hospital, Philadelphia, Pa (A.B.K.). From the 1998 RSNA scientific assembly. Received February 16, 1999; revision requested April 5; revision received September 14; accepted September 24. C.M.C.T. was a GE-AUR Fellow. Supported in part by Public Health Service grant NIH-U01 CA9398-03, awarded by the National Cancer Institute, U.S. Department of Health and Human Services. Address correspondence to C.M.C.T. (e-mail: ctempany@bwh.harvard.edu).

PURPOSE: To compare ultrasonography (US), magnetic resonance (MR) imaging, and computed tomography (CT) for diagnosing and staging advanced ovarian cancer.

MATERIALS AND METHODS: US, CT, and MR imaging were performed in 280 patients. Images were read by three radiologists from each of the five hospitals. Image analysis included determination of malignancy within the peritoneum (11 sites), lymph nodes (10 sites), and hepatic parenchyma. The standard of reference was based on surgical and histopathologic findings. Statistical methods used were receiver operating characteristic (ROC) curve analysis, pairwise comparison of areas under the ROC curves (A_z), analysis of sensitivity and specificity pairs, and assessment of agreement between the degree of suspicion and standard of reference.

RESULTS: There were 118 patients with malignant tumors; 73 (62%) had stage III or IV disease. Metastases were found in the peritoneum in 70 (59%), nodes in 20 (17%), and liver in seven (6%) cases. In the peritoneum, MR imaging and CT (A_z = 0.96 for both) were more accurate than US (A_z = 0.86), especially in the subdiaphragmatic spaces and hepatic surfaces. MR imaging and CT were more sensitive than US (95%, 92%, and 69%, respectively) for peritoneal metastases. MR imaging was more accurate than CT for detection of lymph node metastases (A_z = 0.76 vs 0.57, P = .04). In the liver, the A_z values for the three modalities were 0.77–0.94.

CONCLUSION: CT and MR imaging are equally accurate, and either modality can be used to stage advanced ovarian cancer.

Index terms: Ovary, CT, 852.12113, 852.12115 • Ovary, MR, 852.121411, 852.121415, 852.12143 • Ovary, neoplasms, 852.32, 852.339 • Ovary, US, 852.12983, 852.12984 • Receiver operating characteristic (ROC) curve

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