18F-FDG-PET/MRI Demonstration of Extensive Spinal Cord Metastases in a Patient with Ovarian Carcinoma

Spinal cord involvement is a rare manifestation of metastatic ovarian carcinoma. We report a case of high-grade serous ovarian cancer initially diagnosed in 2020. After cytoreductive surgery and multiple chemotherapy regimens, the patient developed brain metastases followed by small hypermetabolic foci along the spinal canal detected on ¹⁸F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (¹⁸F-FDG PET/MRI). These lesions, primarily located in the cervical region, were confirmed by contrast-enhanced spinal MRI but were more clearly visualized on ¹⁸F-FDG PET/MRI. Intramedullary spinal cord metastases are extremely rare and often underdiagnosed. While MRI remains the standard for anatomical assessment, ¹⁸F-FDG PET/MRI demonstrated superior lesion detection and definition in this case. This highlights the potential of hybrid imaging for improved diagnostic sensitivity in patients with suspected central nervous system involvement.