What is the role of CT scanning in malignant ovarian tumor imaging?

Answer

The primary use of CT scanning is in the evaluation of metastatic disease rather than of the ovarian mass; for the evaluation of the ovarian mass, ultrasonography and MRI are more valuable.^[1] CT scanning is helpful in diagnosing cystic teratomas, 93% of which contain fat and 56% of which are calcified. If a large (>10 cm) soft-tissue mass is present, malignant transformation should be suspected.^[19]

CT scanning also can aid in the evaluation of cystadenomas. A serous cystadenoma has an attenuation similar to that of water, whereas a mucinous cystadenoma has an attenuation closer to that of soft tissue.

The presence of wall and septal thickness and irregularity, as well as the existence of enhancing nodules, suggests malignancy. Although CT scan findings can suggest malignancy, they are not definitive for diagnosis unless metastases are present.

CT scan findings of complex functional cysts, benign ovarian tumors, and inflammatory and/or infectious masses, such as tubo-ovarian abscesses, can mimic ovarian malignancies.

Patients with a new diagnosis of epithelial ovarian cancer are routinely imaged with CT as a part of the initial work-up^[4], and CT is part of the standard of care in patients with high-grade serous ovarian cancer (HGSOC high-grade serous ovarian cancer), where it typically serves as a guide to surgical debulking and to assess response to chemotherapy. Because of frequent diagnosis of HGSOC high-grade serous ovarian cancer at the advanced stage, CT images typically display transcoelomic spread, usually over serosal and peritoneal surfaces.^[20]

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Media Gallery

Transvaginal ultrasonogram shows the right ovary, which contains a cystic mass with a papillary excrescence (arrow). This finding is highly indicative of an ovarian neoplasm.
Transvaginal and color Doppler ultrasonograms of stage I ovarian cancer. Top: Note the marked thickening and irregularity in the wall of this left adnexal cyst. Bottom: Color Doppler ultrasonogram shows very low impedance flow within the wall, which indicates an ovarian tumor.
Transvaginal, color Doppler ultrasonogram shows a solid mass in the left ovary. Low impedance flow is noted within this mass, which is a clear cell carcinoma of the ovary.
Note the marked thickening and irregularity of the wall of this left adnexal cyst.
Color Doppler ultrasonogram shows low impedance flow within the wall, which indicates an ovarian tumor.
Three-dimensional, color Doppler ultrasonogram shows a cystic mass containing a vascular papillary excrescence; this is indicative of ovarian cancer.

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Author

Arthur C Fleischer, MD Professor, Chief of Ultrasound Imaging, Departments of Radiology and Radiological sciences and Obstetrics and Gynecology, Vanderbilt University Medical Center

Arthur C Fleischer, MD is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Society of Radiologists in Ultrasound

Disclosure: Nothing to disclose.

Coauthor(s)

Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine

Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular Imaging

Disclosure: Nothing to disclose.

Specialty Editor Board

Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand

Disclosure: Nothing to disclose.

Karen L Reuter, MD, FACR Professor, Department of Radiology, Lahey Clinic Medical Center

Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Radiological Society of North America

Disclosure: Nothing to disclose.

Chief Editor

Additional Contributors

Harris L Cohen, MD, FACR Chairman, Department of Radiology, Professor of Radiology, Pediatrics, and Obstetrics and Gynecology, University of Tennessee Health Science Center College of Medicine; Radiologist-in-Chief, LeBonheur Children's Hospital; Emeritus Professor of Radiology, The School of Medicine at Stony Brook University

Harris L Cohen, MD, FACR is a member of the following medical societies: American College of Radiology, American Institute of Ultrasound in Medicine, Radiological Society of North America, Society for Pediatric Radiology, Association of Program Directors in Radiology, Society of Radiologists in Ultrasound

Disclosure: Nothing to disclose.

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