Treated ovarian cancer: Comparison of MR imaging with serum CA-125 level and physical examination - A longitudinal study

PURPOSE: To evaluate whether gadolinium-enhanced magnetic resonance (MR) im aging can demonstrate clinically occult tumors in women with treated ovaria n cancer and to compare the diagnostic accuracy of MR imaging, serum CA-125 (ovarian cancer antigen) level, and physical examination: MATERIALS AND METHODS: From 1992 to 1997, a longitudinal study comparing MR imaging findings, CA-125 values, and physical examination results with eve ntual clinical outcome in 69 women with treated ovarian cancer was performe d. Tumor presence was determined with surgery, by an elevated CA-125 value, or with follow-up of patients longitudinally to assess for tumor recurrenc e. Absence of tumor was accepted with a disease-free interval of at least 2 years. RESULTS: Twenty-three of 39 patients in clinical remission with a normal CA -125 level and physical examination result had subclinical tumor proved at laparotomy or clinical follow-up. Gadolinium-enhanced MR imaging correctly demonstrated residual tumor in 20 of 23 patients. In all 69 patients, MR im ages had a 91% sensitivity, 87% specificity, 90% accuracy, and 72% negative predictive value and were superior to serum CA-125 level (53%, 94%, 63%, a nd 38%, respectively) (P < .001) and physical examination (26%, 94%, 43%, a nd 29%, respectively) (P < .001) in the depiction of residual tumor. CONCLUSION: Gadolinium-enhanced MR imaging is a valuable clinical tool in p atients with ovarian cancer. An abnormal MR examination with a normal CA-12 5 value is a strong indication of residual or recurrent tumor.