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In patients with peritoneal carcinomatosis from ovarian cancer, CT is the mainstay for evaluating the extent of disease, while MRI can be used as an adjunct.
Bowel, upper abdomen, mesentery involvement by peritoneal carcinomatosis (BUMPy) are the critical anatomical locations that need to be assessed in patients with ovarian cancer.
Multiple imaging scoring systems have been proposed; however clear communication of the several key disease locations in radiology reports is of paramount importance.
Radiomics shows promise in ovarian cancer because it has the potential to non-invasively capture tumor heterogeneity in space and time and may improve risk-stratification or predict benefit from treatment.
Ovarian cancer is the most common cause of death due to gynecologic malignancies, with more than 70% of patients presenting with advanced stage disease at the time of diagnosis. The extent and distribution of tumor guide primary treatment selection and clinical management. While primary cytoreductive surgery with complete tumor resection improves survival, patients with extensive peritoneal disease may benefit from neoadjuvant chemotherapy first to reduce tumor burden followed by interval cytoreductive surgery. Imaging plays an essential role in triaging patients including selecting patients who may benefit from neoadjuvant chemotherapy before cytoreductive surgery. Interestingly, there are no universally established criteria to predict resectability and local practices depend on local guidelines and surgeon preferences. Nevertheless, certain anatomical tumor locations are known to be difficult to resect and are associated with suboptimal cytoreduction or require special surgical considerations. This review discusses the recent advances in the initial management of patients with ovarian cancer, a practical approach to the assessment and communication of peritoneal metastases locations on CT and MRI. It also explores recent advances in genomics profiling and radiomics that may influence the initial management of these patients.Le texte complet de cet article est disponible en PDF.
Keywords : Computed tomography, Magnetic resonance imaging, Ovarian neoplasm, Peritoneal carcinomatosis
Abbreviations : CT, DWI, ESGO, ESMO, MRI, PCI