Diffusion-weighted Imaging of Ovarian Torsion: Usefulness of Apparent Diffusion Coefficient (ADC) Values for the Detection of Hemorrhagic Infarction

Abstract

Purpose: We undertook this study to evaluate the need for diffusion-weighted (DW) magnetic resonance (MR) imaging in detecting hemorrhagic infarction following ovarian torsion.Methods: The study included 14 consecutive patients aged 12 to 74 years (average age, 36 years) with surgical confirmation of ovarian torsion who underwent 1.5-tesla MR imaging. Pathologically, hemorrhagic infarction was found in 7 patients. We retrospectively reviewed signal intensity on T 1 -, T 2 -, and diffusion-weighted images and apparent diffusion coefficients (ADCs) in swollen ovarian stroma.Results: Fallopian tube thickening was seen in all patients. In patients with ovarian cystic lesion, maximum cyst wall thickness was significantly higher in patients with hemorrhagic infarction (mean, 13.5 « 4.1 mm) than those without (mean, 5.0 « 1.0 mm) (P < .05). Signal intensity did not differ significantly on T 1 -weighted, T 2 -weighted, and DW images between patients with and without hemorrhagic infarction. ADCs were significantly lower in patients with hemorrhagic infarction (1.20 « 0.50 [© 10 ¹3 mm 2 /s]) than those without (2.04 « 0.26 [© 10 ¹3 mm 2 /s]) (P < .01). With an ADC threshold of 1.80 [© 10 ¹3 mm 2 /s], sensitivity for hemorrhagic infarction was 0.88 (7 of 8), and specificity was 1.00 (6 of 6).Conclusion: ADC measurements were useful for detecting hemorrhagic infarction in patients with ovarian torsion.

Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries

“…They found that ADC levels are lower in torsion cases with hemorrhagic infarction compared with patients who do not develop hemorrhagic infarction [14]. Similarly, a preliminary study examined the contribution of DWI in the diagnosis of testicular torsion [21].…”

“…Tissue ischemia results in the deterioration of sodium-potassium pumps, which results from the decrease in ATP levels and the deterioration of the water flow between the extracellular and intracellular areas. DWI provides an obvious contrast between ischemic and normal tissue, and ADC maps obtained from DWI show the limited diffusion numerically [14]. The fact that DWI does not need contrast media makes it more important in the diagnosis of ovarian torsion, especially in pediatric and pregnant patients who have increased incidence of ovarian torsion.…”

“…assessment of molecular diffusion caused by random molecular movement, and has high sensitivity in cytotoxic edema and hemorrhage diagnosis [14].…”

Non-oncologic applications of diffusion-weighted imaging (DWI) in the genitourinary system

“…DWI can also increase the conspicuity of a twisted fallopian tube [22]. To our knowledge, no additional diagnostic yield has been demonstrated in diagnosing ovarian torsion by the addition of DWI sequences, but DWI has been shown to be beneficial in identifying hemorrhagic infarction in torsed ovaries where lower ADC values are seen than in ovaries without hemorrhagic infarction [23].…”

Does sildenafil have protective effects against ovarian ischemia-reperfusion injury in rats?

“…It is generally observed in women in the reproductive age group, and it constitutes around 2.7 % of all gynaecological urgent surgical interventions [2,3]. While the conventional treatment method is the extraction of the torsioned ovary, ovarian detorsion must be implemented for patients in whom the protection of fertility is desired.…”