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

Updated: Apr 23, 2019
  • Author: Arthur C Fleischer, MD; Chief Editor: Eugene C Lin, MD  more...
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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. [20]

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. [21]  

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