Johns Hopkins experts in radiology utilize cutting edge technology in ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scanning to ensure that ovarian cancer diagnosis and surveillance are accurate and precise.
Most ovarian cancer patients with advanced disease who are responding to six to eight cycles of chemotherapy, have a normal physical exam, a normal CA125 and a normal CT scan, will be followed by our team with an appointment every three months for the first two to three years. Appointments consist of a physical and pelvic examination and to measure CA125 levels.
During that same time, CT scans are obtained at six month intervals for the first two to three years. If there is an indeterminate abnormality shown on the CT scan, a combined PET/CT would be used to clarify whether that abnormality is due to scar tissue or recurring tumor.
If there is an elevation of the CA125 and the CT scan is not changed, in most circumstances, this predicts a recurrence of disease, and a combined PET/CT scan would be used to discover the location of the recurrence. These types of recurrence are difficult to distinguish without the novel technology utilized in combined PET/CT. Combined PET/CT scans merge metabolic information to determine if cells look anatomically abnormal as well as whether the cells are metabolizing glucose (sugar) at a very high rate, which is consistent with cancer. Due to the high cost, combined PET/CT is reserved for evaluation of suspected recurrent disease.
For the minority of patients whose CA125 levels are known to stay normal or unchanged even in the presence of cancer, CT scans are performed more frequently, at three month intervals or combined PET/CT scans may be considered.
3D-CT is helpful to provide additional or exquisite anatomical detail for particularly complicated cases. For example, it could be used in preparation for and to assist surgeons in evaluating the vascular structure around a liver tumor. 3D-CT can illuminate the location of each blood vessel surrounding that tumor.
Ultrasound technology with or without color flow Doppler is used as a screening tool or to evaluate ovarian or adenexal masses.