الفهرس 
ANATOMY OF THE OVARYOnly 14 pages are availabe for public view
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Abstract
Despite performing latest technology in the diagnosis and
treatment of ovarian cancer, today it still remains the leadingt
cause of death and the fifth most common cancer death in women.
The main reason of the low rates of 5 years survival is the
recurrence of disease. For this reason imaging modalities has been
focused on early detection of the recurrence.
Despite adequate treatment and complete response,
recurrence is major problem for patients with ovarian cancer. It
has been estimated that 60% of patients diagnosed in an advanced
stage will develop abdominal relapse mainly owing to metastasis
hidden in the peritoneum and to retroperitoneal metastasis .The
commonest sites of relapse were with a pelvic mass (48%),
peritoneal disease(45%), large or small bowel serosal disease
(45%) and nodal disease (33%), most commonly in the paraaortic
region. Unusual sites of recurrence included cerebral, liver, pleura,
muscle, splenic and biliary deposits.
In the pelvis, MRI has been shown to have a 91–93%
overall accuracy for differentiating benign from malignant
adnexal tumors .
The role of MRI in staging ovarian cancer remains a
problem-solving modality MRI had good accuracy for diagnosing
pelvic and abdominal cancer spread in patients with ovarian
cancer, showing 71–87% sensitivity and 44–87% specificity for peritoneal dissemination, and 64% sensitivity and 75% specificity
for pelvic and para-aortic LN metastasis. MRI is recommended in
patients with contraindications to CT, e.g., to use of contrast
agents, in pregnant patients and complementary to inconclusive
CT findings.
MRI may assist in predicting tumor respectability,
particularly in the pelvis. Recently, excellent performance has
been reported for MRI in predicting the presence of residual
ovarian tumors.
18F-FDG PET imaging for ovarian cancer surveillance has
proven useful for detecting early recurrences. Positron emission
tomography (PET), particularly when combined with computed
tomography (CT), has improved the accuracy of staging ovarian
carcinoma. For primary staging of ovarian carcinoma and
detection of recurrent ovarian cancer, best performances have
been reported with fusion PET/CT, which has higher accuracy
than either CT or FD-PET alone.
PET/CT devices offer the benefits of both functional and
morphological imaging, it is also a useful imaging modality in the
detection of recurrence of several cancers and a valuable tool for
diagnosing and staging advanced disease and detecting recurrent
tumor It has been known 18F-FDG PET/CT is superior than
conventional imaging modalities in the restaging of several
cancers by distinguishing recurrence from postoperative and
postradiation changes and detecting small lymph node metastases.
In several studies, the sensitivity and specificity of 18FFDG PET/CT in the detection of ovarian cancer recurrence have
been reported as 83-95% and 71-100%, respectively.
However, due to the limited ability of PET/CT to depict
microscopic or small-volume peritoneal lesions, in cases with a
peritoneal lesion or a subtle peritoneal tumor, MRI has been
shown to be sensitive.Therefore, although MRI has some
limitations for detecting microscopic or small-volume lesions,
MRI is likely to be more helpful at depicting microscopic or
small-volume lesions than PET/CT..