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CT of Epithelial Ovarian Tumors¹

¹ From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Md. Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received January 20, 1999; revision requested February 12 and received March 9; accepted March 16. Address reprint requests to E.K.F., Department of Radiology, Johns Hopkins Hospital, 601 N Caroline St, Baltimore, MD 21287.

Ovarian cancer is the second most common gynecologic malignancy in the United States and causes more deaths than any other cancer of the female reproductive system. Approximately two-thirds of patients have tumors that have spread beyond the pelvis at the time of diagnosis. Ovarian tumors arise from the surface epithelium or mesothelium, germ cells, or the gonadal stroma. Epithelial ovarian tumors include serous, mucinous, endometrioid, clear cell, and undifferentiated tumors. In general, the likelihood of malignancy increases with increasing solid-tissue elements and thicker septa. Surgery is central to the management of ovarian cancer. At the initial exploratory laparotomy, surgicopathologic staging and debulking of the tumor are undertaken. Patients with advanced cancer frequently undergo second-look surgery after chemotherapy to detect any residual disease. CT can provide staging information for preoperative planning and determination of surgical resectability, demonstrate tumor response to therapy, and allow detection of persistent or recurrent disease. However, a major limitation of CT is the lack of sensitivity for detection of small tumor implants, especially on the small intestine or mesentery. Dedicated CT of the pelvis is best performed with spiral CT. Ovarian carcinoma can spread by means of intraperitoneal implantation, lymphatic invasion, and hematogenous dissemination.

Index Terms: Ovary, CT, 852.12115 • Ovary, neoplasms, 852.30

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