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Ovarian Cancer Diagnosis and Staging

Donald G. Mitchell¹, Peter Natale¹, George Holland¹

¹Thomas Jefferson University, Philadelphia, Pennsylvania

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A20.2

DOI:

10.1002/0471142719.mia2002s06

Online Posting Date:

November, 2002

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Abstract

This unit presents a basic protocol for detecting and staging ovarian cancer. The techniques are similar to those used for general imaging of the liver/abdomen and the pelvis for other applications.

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Unit Introduction
Basic Protocol: Ovarian Cancer
Commentary
Bibliography
Figures
Tables

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Materials

Basic Protocol: Ovarian Cancer

Materials

Normal saline (0.9% NaCl), sterile, 100 ml minimum
Extravascular contrast agent (e.g., Magnevist, Omniscan, or Prohance), 20 ml for most patients
1 mg glucagon for intramuscular injection

22-G angiocatheter
Extension tubing (110-in.)
Power injector

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Figures

Figure A20.2.1

Coronal T₂-weighted single-shot FSE sequence used as a localizer, with field of view of 36 cm. White arrow indicates a cystic mass in the left adnexa. Black arrows indicate the lower poles of the kidneys; although they are out of ideal range of the torso phased array coil, image quality is sufficient to verify their locations and lack of collecting system dilatation.

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Figure A20.2.2

Transverse T₂-weighted FSE image. Large white arrow indicates left adnexal cystic mass, which has dependent low signal. Thin white arrow indicates the right ovary, black arrow indicates the uterus. There is a small amount of free pelvic fluid.

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Figure A20.2.3

Transverse T₁-weighted spin echo image at the same level as the image in Figure A20.2.2.

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Figure A20.2.4

In a different patient, with history of ovarian cancer, 2-D fat-suppressed short T_R gradient echo images with T_R/T_E = 19/2 msec, and 30° flip angle, ~5 min after gadolinium chelate injection. Arrows indicate solid enhancing perihepatic tissue consistent with peritoneal metastases.

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Figure A20.2.5

3-D fat-suppressed short T_R gradient echo images before (A), immediately after (B), and 45 sec after (C) gadolinium chelate injection. Through Fourier interpolation, images are reconstructed every 2.5 mm. Large arrow in A indicates the left adnexal cyst, small arrows indicate dependent increased signal intensity. Arrows inC indicate uniform thickness of the enhancing wall of the cyst, without solid or nodular enhancement to suggest tumor. Findings are most compatible with a benign hemorrhagic cyst.

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Figure A20.2.6

In the same patient as in Figures A20.2.1 to A20.2.4, 2-D sagittal fat suppressed short T_R gradient echo images with T_R and T_E = 19/2 msec, and 30° flip angle, about five minutes after gadolinium chelate injection. The cyst wall and surrounding tissues enhance, but there is no internal enhancement.

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Literature Cited

Literature Cited
	Earls, J.P., Rofsky, N.M., Lee, V.S., DeCorato, D.R., Krinsky, G.A., and Weinreb, J.C. 1997. Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: Optimization with a test examination and a power injector. Radiology 202:268-273.
	Shellock, F.G. and Kanal, E. 1996. Magnetic Resonance Bioeffects, Safety, and Patient Management. Lippincott, Philadelphia.
Key References
	Kurtz, A.B., Tsimikas, J.V., Tempany, C.M., Hamper, U.M., Arger, P.H., Bree, R.L., Wechsler, R.J., Francis, I.R., Kuhlman, J.E., Siegelman, E.S., Mitchell, D.G., Silverman, S.G., Brown, D.L., Sheth, S., Coleman, B.G., Ellis, J.H., Kurman, R.J., Caudry, D.J., and McNeil, B.J. 1999. Diagnosis and staging of ovarian cancer: Comparative values of doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis—report of the radiology diagnostic oncology group. Radiology 212:19-27.
A comprehensive multimodality multi-institutional study
	Outwater, E.K., Huang, A.B., Dunton, C.J., Talerman, A., and Capuzzi, D.M. 1997. Papillary projections in ovarian neoplasms: Appearance on MRI. J. Magn. Reson. Imaging. 7:689-695.
MRI-histogic correlation of ovarian cancer
	Semelka, R.C., Lawrence, P.H., Shoenut, J.P., Heywook, M., Kroeker, M.A., and Lotocki, R. 1993. Primary ovarian cancer: Prospective comparison of contrast-enhanced CT and pre- and postcontrast, fat-suppressed MR imaging, with histologic correlation. J. MRI 3:99-106.
Comparison between MRI and CT
	Shellock and Kanal, 1996. See above.
Discussion of safety issues
	Yamashita, Y., Torashima, M., Hatanaka, Y., Harada, M., Higashida, Y., Takahashi, M., Mizutani, H., Tashiro, H., Iwamasa, J., Miyazaki, K., et al. 1995. Adnexal masses: Accuracy of characterization with transvaginal US and precontrast and postcontrast MR imaging. Radiology 194:557-565.
Comparison of MRI to ultrasound
Internet Resources
	http://www.mri.tju.edu
A non-commercial site that lists all body MRI protocols, continually updated, used by updated GE Signa scanners by the Thomas Jefferson University Department of Radiology. Additionally, there are descriptions and explanations of the various pulse sequences, tips for problems solving, examples of clinical applications.