Added value of diffusion weighted MR imaging in the diagnosis of postpartum ovarian vein thrombosis.

Postpartum ovarian vein thrombosis (POVT) is a rare cause of right fossa pain but the diagnosis should be considered in the clinical setting of persistent fever and lower quadrant tenderness in the postpartum period. Although ultrasound is the initial step in the diagnostic work-up right fossa pain, it is often limited by overlying bowel gas and an enlarged puerperal uterus. Therefore, most authors recommend Computed Tomography (CT) as the imaging technique of choice to confirm the clinical suspicion of POVT. Because Magnetic Resonance Imaging (MRI) is less readily available, it is rarely performed for this indication. However, MRI allows not only to make the diagnosis as accurate as CT, but moreover it provides 2 important advantages in compared to CT. First, it avoids ionizing radiation. Secondly, the use of diffusion weighted imaging (DWI) may obviate the administration of intravenous contrast.

Intraperitoneal contrast material combined with CT for detection of peritoneal metastases of ovarian cancer.

OBJECTIVE: To determine the sensitivity and specificity of CT-peritoneography (CT-P) in detecting peritoneal carcinomatosis in primary or recurrent ovarian cancer. METHODS: Twenty-five patients were submitted to a standard abdominal CT (CT) as well as a computed tomography after intraperitoneal infusion of contrast material (CT-P). Twenty patients had ovarian masses clinically suspected to be malignant. In five patients with ovarian cancer who underwent prior debulking surgery, recurrent disease was suspected. RESULTS: In 21/25 patients an ovarian malignancy was histologically confirmed. During surgery peritoneal spread was found in 13 patients; only in 5 cases CT correctly suggested peritoneal metastases (sensitivity 38%). However, in 10/13 women CT-P indicated peritoneal spread, increasing the overall sensitivity from 38% to 77%. Sensitivity varied substantially according to the different abdominal areas, and was lowest in the left subphrenic space (25%). The sensitivity of CT-P was 71% and 72% in the right paracolic gutter and the pelvis, respectively. Sensitivity of CT-P was not found to be size-dependent, but was mainly related to the morphology of the lesions, with 100% sensitivity in nodular lesions, and only 21% sensitivity for flat peritoneal lesions. CT-P did not improve detection of omental metastases, and was not advantageous when ascites was present. Previous surgery reduced overall specificity from 80% to 57%. CONCLUSION: CT-P greatly improved the sensitivity of CT in the preoperative detection of peritoneal spread of ovarian malignancy. However, the technique failed to detect flat peritoneal metastases, and had a low specificity in patients with a history of prior abdominal surgery.