TOPLINE:

Whole-body diffusion-weighted MRI (WB-DWI/MRI) after neoadjuvant chemotherapy (NACT) predicted complete resection at interval debulking surgery (IDS) with more than 93% accuracy in patients with advanced ovarian cancer while demonstrating superior performance over CT.

METHODOLOGY:

• Researchers in Belgium conducted a prospective single-centre study involving 105 patients with non-primary resectable International Federation of Gynecology and Obstetrics (FIGO) stage IIIC/IV ovarian cancer.
• Participants underwent WB-DWI/MRI 2 weeks after completing three courses of NACT.
• Primary outcome measures included the accuracy of WB-DWI/MRI in predicting complete resection at IDS, progression-free survival (PFS), and overall survival (OS) over a median follow-up of at least 6.5 years.
• Surgical exploration combined with histopathologic assessment and postoperative CT imaging served as the primary reference standard for comparison.
• A subgroup analysis compared WB-DWI/MRI with CT in 69 patients who underwent both imaging modalities, and survival analyses assessed PFS and OS using Cox proportional hazards regression.

TAKEAWAY:

• WB-DWI/MRI predicted complete resection with a sensitivity of 97.3%, a specificity of 83.9%, and an accuracy of 93.3%, demonstrating significant concordance with intraoperative findings in identifying disease sites impeding complete resection (P < .001).
• In the subgroup of 69 patients who underwent both imaging modalities, WB-DWI/MRI demonstrated higher accuracy than CT in predicting complete resection (91.3%; 95% CI, 82.1%-96.7% vs 72.5%; 95% CI, 60.4%-82.5%; P < .001).
• MRI-based prediction of complete resection was independently correlated with improved PFS (hazard ratio [HR], 5.43; 95% CI, 3.30-8.91; P < .001) and OS (HR, 4.24; 95% CI, 2.57-6.97; P < .001).
• In multivariable analysis, only MRI-based prediction and preoperative CA-125 remained independently significant predictors of PFS (P < .001 and P = .04, respectively), and only MRI-based prediction remained significant for OS (P < .001).

IN PRACTICE:

"Post-NACT WB-DWI/MRI accurately predicted complete resection at IDS for non-primary resectable FIGO stage IIIC/IV ovarian cancer, and was superior to CT," the authors wrote.

"WB-DWI/MRI prediction of complete resection was an independent predictor of progression-free survival and overall survival. These findings indicate that MRI could enable radiologists to better inform oncological gynaecologists on disease extent, critical for surgical planning and therapeutic decision-making, potentially improving outcomes by better identifying those patients who are most likely to benefit from surgical intervention after NACT," they added.

SOURCE:

This study was led by Vincent Vandecaveye, University Hospitals Leuven, Leuven, Belgium. It was published online on April 04, 2026, in the British Journal of Cancer.

LIMITATIONS:

The single-centre design reflected local surgical and imaging expertise in a tertiary care centre using institutional operability criteria, which may have limited generalisability to other centres with varying radiologic and surgical expertise. CT was performed and available for comparison only in a subset of patients rather than in all study participants. No interobserver agreement analysis was performed because prior studies showed excellent reader reproducibility. However, postchemotherapy WB‑DWI/MRI may be more challenging and may require greater radiologic expertise because treatment-induced fibrosis and partial lesion regression can obscure residual tumour and cause fibrotic changes on anatomical images to be misinterpreted as tumour despite a low signal on DWI.

DISCLOSURES:

The Belgian Foundation against Cancer (Stichting Tegen Kanker - Fondation Contre le Cancer) provided support for this research. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.