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Treated Ovarian Cancer: Comparison of MR Imaging with Serum CA-125 Level and Physical Examination-A Longitudinal Study¹

¹ From the Departments of Diagnostic Radiology, Oncology, and Surgical and Gynecologic Oncology, Sharp and Children's MRI Center, Sharp Memorial Hospital, 7901 Frost St, San Diego, CA 92123. From the 1997 RSNA scientific assembly. Received March 30, 1998; revision requested June 25; revision received August 7; accepted November 6. Address reprint requests to R.N.L.

View larger version (183K): [in a new window]   Figure 1a. Gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 74-year-old woman with stage III ovarian cancer 10 minutes after intravenous gadolinium-based contrast material injection. (a, b) Images obtained in July 1994. The patient presented with symptoms of primary ovarian carcinoma and a markedly elevated serum CA-125 level (28,000 U/mL). (a) Image through the upper part of the abdomen shows bulky tumor extending into the superior recess of the lesser sac (open arrows) and a thin rim of enhancing right subphrenic and perihepatic peritoneal tumor (solid arrows). (b) Image through the middle part of the abdomen shows diffuse enhancing carcinomatosis (arrows) involving the anterior peritoneum, omentum, and bowel serosa. (c, d) Images obtained in February 1995. After multiple cycles of adjuvant chemotherapy, the patient was in clinical remission with a normal serum CA-125 level (7 U/mL) and physical examination. (c) Image through the upper part of the abdomen shows minimal residual right subphrenic tumor (arrows). (d) Image through the middle part of the abdomen shows complete resolution of peritoneal enhancement, which is an indication of response to interval chemotherapy. Residual right subphrenic tumor nodules were confirmed at second-look laparotomy. (e, f) Images obtained in September 1996. The patient presented with clinical evidence of recurrence with an elevated serum CA-125 level (890 U/mL). (e) Image through the upper part of the abdomen shows interval increase in the thick rim of enhancing right subphrenic tumor (arrows). (f) Image through the middle part of the abdomen shows interval tumor recurrence (straight arrows), with anterior peritoneal and serosal small-bowel and right colonic tumor. Note the improved bowel distention owing to the use of 2% barium as the oral contrast material.

View larger version (115K): [in a new window]   Figure 1b. Gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 74-year-old woman with stage III ovarian cancer 10 minutes after intravenous gadolinium-based contrast material injection. (a, b) Images obtained in July 1994. The patient presented with symptoms of primary ovarian carcinoma and a markedly elevated serum CA-125 level (28,000 U/mL). (a) Image through the upper part of the abdomen shows bulky tumor extending into the superior recess of the lesser sac (open arrows) and a thin rim of enhancing right subphrenic and perihepatic peritoneal tumor (solid arrows). (b) Image through the middle part of the abdomen shows diffuse enhancing carcinomatosis (arrows) involving the anterior peritoneum, omentum, and bowel serosa. (c, d) Images obtained in February 1995. After multiple cycles of adjuvant chemotherapy, the patient was in clinical remission with a normal serum CA-125 level (7 U/mL) and physical examination. (c) Image through the upper part of the abdomen shows minimal residual right subphrenic tumor (arrows). (d) Image through the middle part of the abdomen shows complete resolution of peritoneal enhancement, which is an indication of response to interval chemotherapy. Residual right subphrenic tumor nodules were confirmed at second-look laparotomy. (e, f) Images obtained in September 1996. The patient presented with clinical evidence of recurrence with an elevated serum CA-125 level (890 U/mL). (e) Image through the upper part of the abdomen shows interval increase in the thick rim of enhancing right subphrenic tumor (arrows). (f) Image through the middle part of the abdomen shows interval tumor recurrence (straight arrows), with anterior peritoneal and serosal small-bowel and right colonic tumor. Note the improved bowel distention owing to the use of 2% barium as the oral contrast material.

View larger version (162K): [in a new window]   Figure 1c. Gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 74-year-old woman with stage III ovarian cancer 10 minutes after intravenous gadolinium-based contrast material injection. (a, b) Images obtained in July 1994. The patient presented with symptoms of primary ovarian carcinoma and a markedly elevated serum CA-125 level (28,000 U/mL). (a) Image through the upper part of the abdomen shows bulky tumor extending into the superior recess of the lesser sac (open arrows) and a thin rim of enhancing right subphrenic and perihepatic peritoneal tumor (solid arrows). (b) Image through the middle part of the abdomen shows diffuse enhancing carcinomatosis (arrows) involving the anterior peritoneum, omentum, and bowel serosa. (c, d) Images obtained in February 1995. After multiple cycles of adjuvant chemotherapy, the patient was in clinical remission with a normal serum CA-125 level (7 U/mL) and physical examination. (c) Image through the upper part of the abdomen shows minimal residual right subphrenic tumor (arrows). (d) Image through the middle part of the abdomen shows complete resolution of peritoneal enhancement, which is an indication of response to interval chemotherapy. Residual right subphrenic tumor nodules were confirmed at second-look laparotomy. (e, f) Images obtained in September 1996. The patient presented with clinical evidence of recurrence with an elevated serum CA-125 level (890 U/mL). (e) Image through the upper part of the abdomen shows interval increase in the thick rim of enhancing right subphrenic tumor (arrows). (f) Image through the middle part of the abdomen shows interval tumor recurrence (straight arrows), with anterior peritoneal and serosal small-bowel and right colonic tumor. Note the improved bowel distention owing to the use of 2% barium as the oral contrast material.

View larger version (116K): [in a new window]   Figure 1d. Gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 74-year-old woman with stage III ovarian cancer 10 minutes after intravenous gadolinium-based contrast material injection. (a, b) Images obtained in July 1994. The patient presented with symptoms of primary ovarian carcinoma and a markedly elevated serum CA-125 level (28,000 U/mL). (a) Image through the upper part of the abdomen shows bulky tumor extending into the superior recess of the lesser sac (open arrows) and a thin rim of enhancing right subphrenic and perihepatic peritoneal tumor (solid arrows). (b) Image through the middle part of the abdomen shows diffuse enhancing carcinomatosis (arrows) involving the anterior peritoneum, omentum, and bowel serosa. (c, d) Images obtained in February 1995. After multiple cycles of adjuvant chemotherapy, the patient was in clinical remission with a normal serum CA-125 level (7 U/mL) and physical examination. (c) Image through the upper part of the abdomen shows minimal residual right subphrenic tumor (arrows). (d) Image through the middle part of the abdomen shows complete resolution of peritoneal enhancement, which is an indication of response to interval chemotherapy. Residual right subphrenic tumor nodules were confirmed at second-look laparotomy. (e, f) Images obtained in September 1996. The patient presented with clinical evidence of recurrence with an elevated serum CA-125 level (890 U/mL). (e) Image through the upper part of the abdomen shows interval increase in the thick rim of enhancing right subphrenic tumor (arrows). (f) Image through the middle part of the abdomen shows interval tumor recurrence (straight arrows), with anterior peritoneal and serosal small-bowel and right colonic tumor. Note the improved bowel distention owing to the use of 2% barium as the oral contrast material.

View larger version (176K): [in a new window]   Figure 1e. Gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 74-year-old woman with stage III ovarian cancer 10 minutes after intravenous gadolinium-based contrast material injection. (a, b) Images obtained in July 1994. The patient presented with symptoms of primary ovarian carcinoma and a markedly elevated serum CA-125 level (28,000 U/mL). (a) Image through the upper part of the abdomen shows bulky tumor extending into the superior recess of the lesser sac (open arrows) and a thin rim of enhancing right subphrenic and perihepatic peritoneal tumor (solid arrows). (b) Image through the middle part of the abdomen shows diffuse enhancing carcinomatosis (arrows) involving the anterior peritoneum, omentum, and bowel serosa. (c, d) Images obtained in February 1995. After multiple cycles of adjuvant chemotherapy, the patient was in clinical remission with a normal serum CA-125 level (7 U/mL) and physical examination. (c) Image through the upper part of the abdomen shows minimal residual right subphrenic tumor (arrows). (d) Image through the middle part of the abdomen shows complete resolution of peritoneal enhancement, which is an indication of response to interval chemotherapy. Residual right subphrenic tumor nodules were confirmed at second-look laparotomy. (e, f) Images obtained in September 1996. The patient presented with clinical evidence of recurrence with an elevated serum CA-125 level (890 U/mL). (e) Image through the upper part of the abdomen shows interval increase in the thick rim of enhancing right subphrenic tumor (arrows). (f) Image through the middle part of the abdomen shows interval tumor recurrence (straight arrows), with anterior peritoneal and serosal small-bowel and right colonic tumor. Note the improved bowel distention owing to the use of 2% barium as the oral contrast material.

View larger version (115K): [in a new window]   Figure 1f. Gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 74-year-old woman with stage III ovarian cancer 10 minutes after intravenous gadolinium-based contrast material injection. (a, b) Images obtained in July 1994. The patient presented with symptoms of primary ovarian carcinoma and a markedly elevated serum CA-125 level (28,000 U/mL). (a) Image through the upper part of the abdomen shows bulky tumor extending into the superior recess of the lesser sac (open arrows) and a thin rim of enhancing right subphrenic and perihepatic peritoneal tumor (solid arrows). (b) Image through the middle part of the abdomen shows diffuse enhancing carcinomatosis (arrows) involving the anterior peritoneum, omentum, and bowel serosa. (c, d) Images obtained in February 1995. After multiple cycles of adjuvant chemotherapy, the patient was in clinical remission with a normal serum CA-125 level (7 U/mL) and physical examination. (c) Image through the upper part of the abdomen shows minimal residual right subphrenic tumor (arrows). (d) Image through the middle part of the abdomen shows complete resolution of peritoneal enhancement, which is an indication of response to interval chemotherapy. Residual right subphrenic tumor nodules were confirmed at second-look laparotomy. (e, f) Images obtained in September 1996. The patient presented with clinical evidence of recurrence with an elevated serum CA-125 level (890 U/mL). (e) Image through the upper part of the abdomen shows interval increase in the thick rim of enhancing right subphrenic tumor (arrows). (f) Image through the middle part of the abdomen shows interval tumor recurrence (straight arrows), with anterior peritoneal and serosal small-bowel and right colonic tumor. Note the improved bowel distention owing to the use of 2% barium as the oral contrast material.

View larger version (36K): [in a new window]   Figure 2. Graph shows the combined performance of MR imaging, the CA-125 level, and the physical examination (PE) in determining tumor presence in treated ovarian cancer.

View larger version (151K): [in a new window]   Figure 3a. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 77-year-old woman with treated stage III ovarian cancer 10 minutes following intravenous gadolinium-based contrast material injection. (a, b) Images obtained in February 1994. The patient's CA-125 level was normal (8 U/mL) following adjuvant chemotherapy. Second-look laparotomy revealed no residual tumor. Peritoneal washings were not submitted. (a) Image through the upper part of the abdomen shows residual enhancing right subphrenic tumor (arrows). (b) Image through the middle part of the abdomen shows normal tissue. (c, d) Images obtained in May 1995. The patient's CA-125 level was still normal (20 U/mL). (c) Image through the upper part of the abdomen shows persistent enhancing right subphrenic tumor (arrows), which is more nodular in appearance. (d) Image through the middle part of the abdomen shows a new 2-cm mass (long arrow) anteriorly on the right and an irregular enhancing tumor (short arrow) on the left. (e, f) Images obtained in September 1996. The patient had an elevated CA-125 level (103 U/mL) and presented with clinical evidence of tumor progression. (e) Image through the upper part of the abdomen shows right subphrenic tumor (solid arrows) and new biliary obstruction due to periportal extension (open arrows) of peritoneal tumor. (f) Image through the middle part of the abdomen shows enlargement of the right-sided anterior mass (curved arrow).

View larger version (116K): [in a new window]   Figure 3b. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 77-year-old woman with treated stage III ovarian cancer 10 minutes following intravenous gadolinium-based contrast material injection. (a, b) Images obtained in February 1994. The patient's CA-125 level was normal (8 U/mL) following adjuvant chemotherapy. Second-look laparotomy revealed no residual tumor. Peritoneal washings were not submitted. (a) Image through the upper part of the abdomen shows residual enhancing right subphrenic tumor (arrows). (b) Image through the middle part of the abdomen shows normal tissue. (c, d) Images obtained in May 1995. The patient's CA-125 level was still normal (20 U/mL). (c) Image through the upper part of the abdomen shows persistent enhancing right subphrenic tumor (arrows), which is more nodular in appearance. (d) Image through the middle part of the abdomen shows a new 2-cm mass (long arrow) anteriorly on the right and an irregular enhancing tumor (short arrow) on the left. (e, f) Images obtained in September 1996. The patient had an elevated CA-125 level (103 U/mL) and presented with clinical evidence of tumor progression. (e) Image through the upper part of the abdomen shows right subphrenic tumor (solid arrows) and new biliary obstruction due to periportal extension (open arrows) of peritoneal tumor. (f) Image through the middle part of the abdomen shows enlargement of the right-sided anterior mass (curved arrow).

View larger version (154K): [in a new window]   Figure 3c. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 77-year-old woman with treated stage III ovarian cancer 10 minutes following intravenous gadolinium-based contrast material injection. (a, b) Images obtained in February 1994. The patient's CA-125 level was normal (8 U/mL) following adjuvant chemotherapy. Second-look laparotomy revealed no residual tumor. Peritoneal washings were not submitted. (a) Image through the upper part of the abdomen shows residual enhancing right subphrenic tumor (arrows). (b) Image through the middle part of the abdomen shows normal tissue. (c, d) Images obtained in May 1995. The patient's CA-125 level was still normal (20 U/mL). (c) Image through the upper part of the abdomen shows persistent enhancing right subphrenic tumor (arrows), which is more nodular in appearance. (d) Image through the middle part of the abdomen shows a new 2-cm mass (long arrow) anteriorly on the right and an irregular enhancing tumor (short arrow) on the left. (e, f) Images obtained in September 1996. The patient had an elevated CA-125 level (103 U/mL) and presented with clinical evidence of tumor progression. (e) Image through the upper part of the abdomen shows right subphrenic tumor (solid arrows) and new biliary obstruction due to periportal extension (open arrows) of peritoneal tumor. (f) Image through the middle part of the abdomen shows enlargement of the right-sided anterior mass (curved arrow).

View larger version (109K): [in a new window]   Figure 3d. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 77-year-old woman with treated stage III ovarian cancer 10 minutes following intravenous gadolinium-based contrast material injection. (a, b) Images obtained in February 1994. The patient's CA-125 level was normal (8 U/mL) following adjuvant chemotherapy. Second-look laparotomy revealed no residual tumor. Peritoneal washings were not submitted. (a) Image through the upper part of the abdomen shows residual enhancing right subphrenic tumor (arrows). (b) Image through the middle part of the abdomen shows normal tissue. (c, d) Images obtained in May 1995. The patient's CA-125 level was still normal (20 U/mL). (c) Image through the upper part of the abdomen shows persistent enhancing right subphrenic tumor (arrows), which is more nodular in appearance. (d) Image through the middle part of the abdomen shows a new 2-cm mass (long arrow) anteriorly on the right and an irregular enhancing tumor (short arrow) on the left. (e, f) Images obtained in September 1996. The patient had an elevated CA-125 level (103 U/mL) and presented with clinical evidence of tumor progression. (e) Image through the upper part of the abdomen shows right subphrenic tumor (solid arrows) and new biliary obstruction due to periportal extension (open arrows) of peritoneal tumor. (f) Image through the middle part of the abdomen shows enlargement of the right-sided anterior mass (curved arrow).

View larger version (163K): [in a new window]   Figure 3e. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 77-year-old woman with treated stage III ovarian cancer 10 minutes following intravenous gadolinium-based contrast material injection. (a, b) Images obtained in February 1994. The patient's CA-125 level was normal (8 U/mL) following adjuvant chemotherapy. Second-look laparotomy revealed no residual tumor. Peritoneal washings were not submitted. (a) Image through the upper part of the abdomen shows residual enhancing right subphrenic tumor (arrows). (b) Image through the middle part of the abdomen shows normal tissue. (c, d) Images obtained in May 1995. The patient's CA-125 level was still normal (20 U/mL). (c) Image through the upper part of the abdomen shows persistent enhancing right subphrenic tumor (arrows), which is more nodular in appearance. (d) Image through the middle part of the abdomen shows a new 2-cm mass (long arrow) anteriorly on the right and an irregular enhancing tumor (short arrow) on the left. (e, f) Images obtained in September 1996. The patient had an elevated CA-125 level (103 U/mL) and presented with clinical evidence of tumor progression. (e) Image through the upper part of the abdomen shows right subphrenic tumor (solid arrows) and new biliary obstruction due to periportal extension (open arrows) of peritoneal tumor. (f) Image through the middle part of the abdomen shows enlargement of the right-sided anterior mass (curved arrow).

View larger version (125K): [in a new window]   Figure 3f. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 77-year-old woman with treated stage III ovarian cancer 10 minutes following intravenous gadolinium-based contrast material injection. (a, b) Images obtained in February 1994. The patient's CA-125 level was normal (8 U/mL) following adjuvant chemotherapy. Second-look laparotomy revealed no residual tumor. Peritoneal washings were not submitted. (a) Image through the upper part of the abdomen shows residual enhancing right subphrenic tumor (arrows). (b) Image through the middle part of the abdomen shows normal tissue. (c, d) Images obtained in May 1995. The patient's CA-125 level was still normal (20 U/mL). (c) Image through the upper part of the abdomen shows persistent enhancing right subphrenic tumor (arrows), which is more nodular in appearance. (d) Image through the middle part of the abdomen shows a new 2-cm mass (long arrow) anteriorly on the right and an irregular enhancing tumor (short arrow) on the left. (e, f) Images obtained in September 1996. The patient had an elevated CA-125 level (103 U/mL) and presented with clinical evidence of tumor progression. (e) Image through the upper part of the abdomen shows right subphrenic tumor (solid arrows) and new biliary obstruction due to periportal extension (open arrows) of peritoneal tumor. (f) Image through the middle part of the abdomen shows enlargement of the right-sided anterior mass (curved arrow).

View larger version (142K): [in a new window]   Figure 4a. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained 10 minutes following intravenous gadolinium injection in a 63-year-old woman 4 years after the initial diagnosis of stage IV ovarian cancer. (a, b) Images obtained in September 1994. The patient's CA- 125 level was normal (12 U/mL), and her physical examination was unremarkable. (a) Coronal image shows a 5-cm cystic posterior subhepatic mass (arrow). (b) Axial image shows an enhancing perisplenic tumor (arrows). (c, d) Images obtained in September 1995. The patient's CA- 125 level was elevated (47 U/mL). (c) Coronal image shows enlarging 8-cm subhepatic mass (arrow) with a mural nodule. (d) Axial image through the upper part of the abdomen shows increasing bulky perisplenic tumor (arrows) and enhancing right subhepatic tumor (arrowheads). (e) Image through the pelvis obtained in September 1995 shows a 2-cm mesenteric mass (arrowhead). The diffuse serosal small-bowel enhancement (straight arrows) represents peritoneal tumor spread. Abnormal enhancement and thickening of the sigmoid colon (curved arrow) is also noted.

View larger version (123K): [in a new window]   Figure 4b. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained 10 minutes following intravenous gadolinium injection in a 63-year-old woman 4 years after the initial diagnosis of stage IV ovarian cancer. (a, b) Images obtained in September 1994. The patient's CA- 125 level was normal (12 U/mL), and her physical examination was unremarkable. (a) Coronal image shows a 5-cm cystic posterior subhepatic mass (arrow). (b) Axial image shows an enhancing perisplenic tumor (arrows). (c, d) Images obtained in September 1995. The patient's CA- 125 level was elevated (47 U/mL). (c) Coronal image shows enlarging 8-cm subhepatic mass (arrow) with a mural nodule. (d) Axial image through the upper part of the abdomen shows increasing bulky perisplenic tumor (arrows) and enhancing right subhepatic tumor (arrowheads). (e) Image through the pelvis obtained in September 1995 shows a 2-cm mesenteric mass (arrowhead). The diffuse serosal small-bowel enhancement (straight arrows) represents peritoneal tumor spread. Abnormal enhancement and thickening of the sigmoid colon (curved arrow) is also noted.

View larger version (137K): [in a new window]   Figure 4c. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained 10 minutes following intravenous gadolinium injection in a 63-year-old woman 4 years after the initial diagnosis of stage IV ovarian cancer. (a, b) Images obtained in September 1994. The patient's CA- 125 level was normal (12 U/mL), and her physical examination was unremarkable. (a) Coronal image shows a 5-cm cystic posterior subhepatic mass (arrow). (b) Axial image shows an enhancing perisplenic tumor (arrows). (c, d) Images obtained in September 1995. The patient's CA- 125 level was elevated (47 U/mL). (c) Coronal image shows enlarging 8-cm subhepatic mass (arrow) with a mural nodule. (d) Axial image through the upper part of the abdomen shows increasing bulky perisplenic tumor (arrows) and enhancing right subhepatic tumor (arrowheads). (e) Image through the pelvis obtained in September 1995 shows a 2-cm mesenteric mass (arrowhead). The diffuse serosal small-bowel enhancement (straight arrows) represents peritoneal tumor spread. Abnormal enhancement and thickening of the sigmoid colon (curved arrow) is also noted.

View larger version (133K): [in a new window]   Figure 4d. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained 10 minutes following intravenous gadolinium injection in a 63-year-old woman 4 years after the initial diagnosis of stage IV ovarian cancer. (a, b) Images obtained in September 1994. The patient's CA- 125 level was normal (12 U/mL), and her physical examination was unremarkable. (a) Coronal image shows a 5-cm cystic posterior subhepatic mass (arrow). (b) Axial image shows an enhancing perisplenic tumor (arrows). (c, d) Images obtained in September 1995. The patient's CA- 125 level was elevated (47 U/mL). (c) Coronal image shows enlarging 8-cm subhepatic mass (arrow) with a mural nodule. (d) Axial image through the upper part of the abdomen shows increasing bulky perisplenic tumor (arrows) and enhancing right subhepatic tumor (arrowheads). (e) Image through the pelvis obtained in September 1995 shows a 2-cm mesenteric mass (arrowhead). The diffuse serosal small-bowel enhancement (straight arrows) represents peritoneal tumor spread. Abnormal enhancement and thickening of the sigmoid colon (curved arrow) is also noted.

View larger version (147K): [in a new window]   Figure 4e. Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained 10 minutes following intravenous gadolinium injection in a 63-year-old woman 4 years after the initial diagnosis of stage IV ovarian cancer. (a, b) Images obtained in September 1994. The patient's CA- 125 level was normal (12 U/mL), and her physical examination was unremarkable. (a) Coronal image shows a 5-cm cystic posterior subhepatic mass (arrow). (b) Axial image shows an enhancing perisplenic tumor (arrows). (c, d) Images obtained in September 1995. The patient's CA- 125 level was elevated (47 U/mL). (c) Coronal image shows enlarging 8-cm subhepatic mass (arrow) with a mural nodule. (d) Axial image through the upper part of the abdomen shows increasing bulky perisplenic tumor (arrows) and enhancing right subhepatic tumor (arrowheads). (e) Image through the pelvis obtained in September 1995 shows a 2-cm mesenteric mass (arrowhead). The diffuse serosal small-bowel enhancement (straight arrows) represents peritoneal tumor spread. Abnormal enhancement and thickening of the sigmoid colon (curved arrow) is also noted.

View larger version (156K): [in a new window]   Figure 5a. (a, b) Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 60-year-old woman with stage III ovarian cancer 10 minutes following intravenous gadolinium injection. Following multiple cycles of chemotherapy, the CA-125 level decreased to the normal range (34 U/mL), and the physical examination results were normal. (a) Coronal image shows a large residual mesenteric mass (arrow). (b) Axial image shows ascites (curved arrows), an enhancing subphrenic tumor (long arrows), and a tumor in the left intersegmental fissure (open arrow).

View larger version (115K): [in a new window]   Figure 5b. (a, b) Breath-hold fast multiplanar spoiled gradient-recalled-echo MR images (140/2.6, 70° flip angle) with fat saturation obtained in a 60-year-old woman with stage III ovarian cancer 10 minutes following intravenous gadolinium injection. Following multiple cycles of chemotherapy, the CA-125 level decreased to the normal range (34 U/mL), and the physical examination results were normal. (a) Coronal image shows a large residual mesenteric mass (arrow). (b) Axial image shows ascites (curved arrows), an enhancing subphrenic tumor (long arrows), and a tumor in the left intersegmental fissure (open arrow).