Ovarian cancer MRI

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Monalisa Dmello, M.B,B.S., M.D. [2] Huda A. Karman, M.D.

Ovarian cancer Microchapters
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Overview

MRI of the pelvis, abdomen, and chest can be helpful as one of the evaluating tools of ovarian cancer and its extent and metastasis. CT scan be used for preoperative staging to look for lymphadenopathy, peritoneal, and distant metastases.

MRI

Endometrioid carcinoma of the ovary

Pelvic MRI: Reported signal characteristics include:

• T2:
  • Relatively low signal intensity of the tumor wall
  • Shading sign may be seen
• T1C+(Gd):
  • Can show mild enhancement

Ovarian serous cystadenocarcinoma

• MRI is the modality of choice in the characterization of ovarian malignancy and in the detection of lymphatic, peritoneal, and distant metastases.
• Both for preoperative planning and post-treatment follow up.
• The cystic components
  • Are high T2, low T1 signal
  • If there has been intralesional hemorrhage (c.f. mucinous cystadenocarcinoma, there is typically slightly increased T1 signal of the cystic component)
• Solid malignant components
  • Demonstrate intermediate T1 and T2 signal, restricted diffusion, and gadolinium enhancement.
• DWI is useful for the detection of distant metastases.

Ovarian mucinous cystadenocarcinoma

• T1:
  • The signal intensity of mucin on T1-weighted images varies depending on the degree of mucin concentration
  • On T1-weighted images, loculi with watery mucin have a lower signal intensity than loculi with thicker mucin.
• T2
  • On T2-weighted images, the corresponding signal intensities are flipped, so that loculi with watery mucin have a high signal intensity and loculi with thicker mucin appear slightly hypointense.
• MRI
• Often seen as a cystic ovarian mass with the margin being generally smooth. Solid protrusions are often both round and few in number.
• Reported signal characteristics include:
• T1: can vary from low to very high (often dependent on the hemorrhagic component(s), not a specific feature)