The reason preoperative staging has been controversial is that the diagnosis is established histologically, and patients with almost all stages of disease tend to get surgery or surgery with adjuvant therapy, with the exception of advanced Stage III and Stage IV tumors. For ovarian cancer, the goal is to show the full extent of disease. But there is currently no effective cross-sectional imaging technique to accurately show the full extent of disease preoperatively, as many lesions that spread from ovarian cancer are tiny and very difficult to see. These include lesions in the peritoneum and in the omentum. Enhancing tumor on a background of dark fat is shown to best advantage even in the omentum or peritoneum.
Gadolinium enhancement optimizes the contrast of the lesion in relation to surrounding tissue.
Most patients with ovarian cancer eventually go to surgery for diagnostic and therapeutic initial evaluation. Ovarian cancer is generally staged and surgically treated at the same time. That is where cross-sectional imaging comes in. The argument for cross-sectional imaging is that one can predict the extent of the disease from preoperative scanning imaging. Following with chemotherapy may be preferable to initial surgical cytoreduction in patients if they start out with non-resectable disease.