Role of Integrated 18-F FDG PET/CT in Recurrent Ovarian Cancer

Carcinoma of the ovary is the third most common cancer of the female genital tract but it accounts for over half of all deaths related to gynecologic neoplasms. This is primarily because, unlike patients with other common malignant gynecologic tumors, most patients with ovarian cancer have advanced stage of disease at the time of initial diagnosis. After completion of initial surgery, patients with ovarian cancer receive systemic chemotherapy for disease control. Despite the fact that ovarian cancer is very sensitive to platinum-based chemotherapy, 5-year survival for patients with advanced disease is only 17%, due to the high rate of recurrent disease. Although its limited accuracy, serial determination of the tumor marker CA 125 is the most frequently used method for monitoring the disease. Morphologic imaging modalities have played a major role to accurately delineate disease status. Computed tomography (CT) proved to be useful for evaluating response to treatment in these patients. Fluorodeoxyglucose (FDG) positron emission tomography ( PET), which provides metabolic information useful in the identification of cancer tissue, also proved to be of value for the assessment of recurrent ovarian cancer. Recently, a new imaging technique combining state of the art PET and CT equipments ( integrated PET/CT) has been introduced in clinical use. PET/CT device acquires PET and CT images, that are contemporaneous and coregistered, to localize elevated FDG uptake with improved anatomic specificity. Potential advantages of PET/CT include increased lesion conspicuity, anatomic localization of lesions, and differentiation of neoplastic disease process from postreatment fibrosis. In this article we illustrate the role of PET/CT relative to CT and MR imaging in the field of recurrent ovarian cancer.