**Acknowledgements**

patients with OC for improved intra-operative staging and more radical cytoreductive surgery [55]. Additionally, optical coherence tomography (OCT) is another emerging high-resolution imaging technique that utilises an infrared light source directed to the tissues being examined. A novel prototype intra-operative OCT system combining positron detections; namely utilising Caesium (Tl204/Cs137) sources as well as 18F-FDG have shown potential for the development of a miniaturised laparoscopic probe to detect small volume disease of OC. This can offer simultaneous functional localisation and structural imaging for improved early cancer detection [56].

In summary, ovarian cancer is a heterogeneous spectrum of disease. Early detection and accurate staging using diagnostic imaging can help improve the prognosis of this condition. Prudent selection of the appropriate imaging modality can help expedite the correct treatment being instituted for the patients (**Table 3**). Molecular imaging, particularly 18F-FDG PET/CT can be a useful non-invasive biomarker to help stage the disease and detect recur-

• Operator dependent

• Relatively expensive • Longer scanning time • Requires specialised skills for

interpretation

interpretation

interpretation

• Operator dependent

interpretation

• Requires specialised skills for

• Longer scanning time • Requires specialised skills for

• Expensive

• Costly

• Involves ionising radiation • Prone to false positive results • Requires specialised skills for

findings

• Involves ionising radiation

• Unable to accurately stage the disease

• Has pitfalls that lead to falsely negative

rence based on the proposed diagnostic algorithm in this chapter.

• Does not involve ionising radiation

MRI • Excellent soft tissue detail and able to characterise

• Does not involve ionising radiation

• Good for detection of extra-abdominal metastases

detection of nodal and peritoneal metastases • Slightly reduced radiation dose compared to pet/CT

• Able to delineate local extent of disease in a small

**Table 3.** Comparison of the diagnostic imaging modalities for the management of ovarian cancer.

PET/CT • Excellent for staging and detection of recurrence

PET/MRI • Excellent soft tissue detail and able to improve

• Able to detect small volume disease

region of interest

**Modality Advantage Disadvantage**

**3. Conclusion**

188 Ovarian Cancer - From Pathogenesis to Treatment

Ultrasound • Relatively cheap

CT scan • Good for staging

Intra-operative devices

• Easily available

• Readily available

the pelvic lesion

I would like to express my gratitude to the Dean of the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Professor Dato' Dr. Abdul Jalil Nordin; and the Lead Consultant from the Nuclear Medicine Department at the Royal Liverpool and Broadgreen University Hospitals, NHS Trusts, Liverpool, the United Kingdom of Great Britain, Professor Dr. Sobhan Vinjamuri, my mentors; for their invaluable comments during preparation of this manuscript. I would also like to acknowledge Universiti Putra Malaysia research grant GP/IPM/2014/9404000 and GP/2017/9549800 that helped fund this project; and the fellowship training scholarship awarded by the International Atomic Energy Agency (IAEA) that enabled the collaboration with the United Kingdom counterparts. I would also like to thank the Director of the Centre for Diagnostic Nuclear Imaging, UPM; Associate Professor Dr. Fathinul Fikri Ahmad Saad for giving permission to use images from the centre as well as the Director General of Health, Ministry of Health Malaysia for giving permission to use images from Serdang Hospital, Malaysia.
