Enhanced MRI greatly aids search for ovarian cancer recurrences. (Adjunct to Second-Look Laparotomy).

CHICAGO -- Use of gadolinium-enhanced MRI as an adjunct to second-look laparotomy and serum markers can significantly improve the ability to identify ovarian cancer recurrences, experts said at the annual meeting of the Radiological Society of North America.

CT scans are still helpful for guiding surgical decisions.

Historically, up to 50% of women with negative second-look surgery results will actually have a recurrence of cancer, suggesting that laparotomy could be missing residual tumors. A big part of the problem is that second-look laparotomies can be very difficult to perform, especially when thick adhesions freeze up the upper abdomen and bar access to it, said Dr. Russell N. Low, a radiologist at the University of California, San Diego.

In a study of 55 women who had been treated for ovarian cancer, Dr. Low and his associates investigated the accuracy of fat-suppressed, gadolinium-enhanced, spoiled gradient-recalled echo (SGE) MRI for depicting residual tumor.

All patients underwent the MRI of the abdomen and the pelvis just before undergoing laparotomy. Even if the MRI and/or second-look laparotomy was clean, the patient was not declared cancer free until that status was confirmed by all factors, including serum tumor markers, on follow-up 1 year later.

Overall, 49 women had residual tumor according to surgery and biopsy findings; 6 had no evidence of tumors.

The MRI depicted residual tumor in 43 of the 49 patients for a sensitivity of 88%, a specificity of 83%, and an accuracy rate of 87%.