The role of FDG PET/CT imaging in detection of recurrent ovarian cancer (OC)

1091 Learning Objectives 1. Understand the role of FDG PET/CT in the restaging of ovarian cancer. 2. Illustrate the patterns of locoregional and distant recurrence. 3. Illustrate PET/CT pitfalls. OC is the fifth leading cause of cancer death in females with a high likelihood of recurrence despite aggressive therapies. Our aim is to evaluate the clinical utility of FDG-PET/CT imaging for detecting recurrent OC. After initial treatment, OC patients are rigorously monitored with follow-up visits, serial tumor markers, imaging and second-look procedures. CT/MRI has the benefit of excellent anatomic definition but provides no information regarding metabolic characterization of the structural abnormalities. PET/CT is more sensitive than conventional imaging modalities in detecting recurrent OC with a sensitivity and specificity of 88-94% and 81-93%respectively. The most common site of recurrence occurs in the peritoneum, thay may be demonstrated as hypermetabolic soft tissue masses or as diffuse uptake on PET/CT imaging. These implants are most commonly seen in the cul-de-sac and mesocolon. Recurrence can occur within the pelvic or paraaortic lymph nodes. Distant organ metastases are the least common form of recurrence. However, PET/CT has limitations including false negatives seen in mucinous OC and diffuse peritoneal involvement. False positives can occur in the setting of infection/inflammation. Thus, there is a need to understand the characteristic disease distribution and pitfalls in the setting of suspected recurrence. This review will include a series of OC PET/CT cases demonstrating local recurrence in the pelvis, peritoneal involvement, pelvic/retroperitoneal lymph node metastases, distant organs involvement. False negative and false positive cases will also be reviewed to enhance the awareness of associated pitfalls for more accurate interpretation. The expanded body of knowledge may help to accurately identify recurrent OC in a timely fashion that may have an impact on clinical management