Imaging is used as a noninvasive means to determine whether there is a mass lesion or other cause for a patient’s symptoms and physical examination findings.

In this context, the main purposes of imaging are to:

  1. Characterize whether the adnexal mass shows malignant features


  1. Determine whether the adnexal mass is resectable.

Collectively, imaging provides the clinician with a better understanding of tumor size, extension or involvement of other abdominal or pelvic organs, masses which press upon other organs, and involvement of distant sites such as: liver, spleen, lung, bone, or brain.

Main Imaging Modalities in Ovarian Cancer: Diagnosis, Clinical Staging, & Monitoring
Modality Utility
Ultrasound (US) Diagnostic evaluation tool

Combined with serum CA-125 for Risk of Malignancy Index (RMI) (>200 highly specific for malignancy)

Not used for clinical staging
       Transvaginal US (TVUS) Distinguishing malignant from benign adnexal masses by architectural features:
  • Larger size
  • Thick, irregular walls
  • Papillary projections
  • Solid areas
       Transabdominal US (TAUS) When mass is too large to evaluate by TVUS

Assesses pelvic, abdominal & retroperitoneal structures
Computed Tomography (CT) Diagnostic function, especially when ascites present

Clinical Staging

Monitoring recurrence & progression
Magnetic Resonance Imaging (MRI) Evaluation of indeterminate malignancy adnexal mass on US

Identification of pelvic organ invasion

Assessment of patients with increased serum CA-125 levels & negative abdominopelvic CT findings
Positron Emission Tomography (PET)/CT Ovarian cancer staging

Monitoring disease progression

Little use in characterizing complex adnexal tumors

Updated: June 8, 2018