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Acta Radiol. 2019 May 12:284185119842832. doi: 10.1177/0284185119842832. [Epub ahead of print]

Patterns of initially overlooked recurrence of peritoneal lesions in patients with advanced ovarian cancer on postoperative multi-detector row CT.

Author information

1
1 Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
2
2 Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
3
3 Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Abstract

BACKGROUND:

In order to obtain timely treatment, the early detection of recurrent ovarian cancer is essential. Despite technical advances in multi-detector row computed tomography (MDCT), low sensitivity of CT for recurrence has not been improved much due to its poor soft tissue discrimination.

PURPOSE:

The aim of this study is to describe patterns of erroneous postoperative MDCT interpretation of recurred peritoneal lesions in patients with advanced ovarian cancer (AOC).

MATERIAL AND METHODS:

Between 2011 and 2018, we reviewed postoperative follow-up positron emission tomography (PET)/CT images of 240 patients with suspected recurrence based on the images and history of initially diagnosed AOC (International Federation of Gynecology and Obstetrics stage IIIC-IV) who had undergone primary cytoreduction. With awareness of recurred location, we re-evaluated MDCT images taken right before the recurrence was detected on PET/CT and categorized these cases as either the absence of a lesion or the presence of a lesion (missed case). We performed region-based comparisons of these missed cases according to predefined peritoneal locations.

RESULTS:

Re-evaluation of follow-up MDCT images revealed that 46.9% (105/224) of recurrent lesions were missed. Through region-based analysis, the most commonly missed site was the pelvic cavity (19.0%, 20/105), followed by the porta hepatis (15.2%, 16/105) and the para-aortic/aortocaval lymphadenopathy (13.3%, 14/105).

CONCLUSION:

Radiologists should be concerned about these frequently overlooked regions in postoperative follow-up MDCT images when potential risks are identiļ¬ed. Familiarity with these imaging features may aid in the detection of recurrence and facilitate appropriate management.

KEYWORDS:

CT; Genital/reproductive; PET; adults; ovaries; treatment effects

PMID:
31081339
DOI:
10.1177/0284185119842832

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