Predictive Value of Single or Combined Ultrasound Signs in the Diagnosis of Ovarian Torsion

Abstract

Objectives To determine predictive values of isolated and combined ultrasound signs in the diagnosis of adnexal torsion. Methods This work was a retrospective study of 129 adult female patients who underwent an ultrasound examination followed by a definitive surgical procedure within a 24‐hour period to determine whether adnexal torsion was present. Results The positive predictive value (PPV) of the ultrasound diagnosis of adnexal torsion was 82.2%. The statistically significant ultrasound signs in multivariate logistic regression with single‐predictor analyses were relative enlargement of the ovary, an abnormal adnexal position, a twisted vascular pedicle, and the follicular edema “ring sign.” Possible combinations of these ultrasound criteria showed high specificities (74%–100%), high PPVs (93%–100%), and lower sensitivities (29%–71%) and negative predictive values (24%–35%). Any combination that included a twisted vascular pedicle or the follicular ring sign as one of the signs had high odds ratios and positive likelihood ratios. Conclusions Ultrasound has a high PPV as a first‐choice imaging modality in the diagnosis of adnexal torsion. The combinations of the following 4 statistically significant ultrasound signs, consisting of an abnormal position, relative enlargement of the index ovary, a twisted vascular pedicle, and the follicular edema ring sign, substantially narrow the imaging differential diagnosis in such cases. The presence of vascular pedicle twisting and the follicular ring sign was highly associated with a positive ovarian torsion diagnosis, with 100% specificity.

Ultrasonographic scoring system for the diagnosis of adnexal torsion

“…However, in their research, a few low‐quality ultrasonographic images with imperfect information were included, and this limits the reliability of that study. Yatsenko et al 22 studied combinations of the following some ultrasound signs to substantially narrow the imaging differential diagnosis, as follows: abnormal adnexal position, relative enlargement of the index ovary, a twisted vascular pedicle, and the follicular edema ring sign. Notably, the presence of the follicular ring sign or the absence of Doppler signals in the twisted organ was infrequent in our study, and this was consistent with the reports of other previous studies 19,21 …”

“…An abnormal adnexal position was another commonly encountered sign in our study (Figure 6), with a sensitivity of 79.17% and a moderate specificity of 41.30%. It was once thought to be a diagnostic criterion using computed tomography and magnetic resonance imaging in cases of low diagnosis rate for ultrasound imaging, 24–26 but a recent report suggests that this sign is a promising ultrasound marker 22 …”

“…It was once thought to be a diagnostic criterion using computed tomography and magnetic resonance imaging in cases of low diagnosis rate for ultrasound imaging, [24][25][26] but a recent report suggests that this sign is a promising ultrasound marker. 22 Since one ultrasound sign provides a restricted prognosticative worth for the definitive identification of gonad torsion, we sought-after and determined a combination of various sonographic findings to establish a diagnostic scoring system based on five reproducible criteria.…”

Characteristics and Risk Factors for Ischemic Ovary Torsion in Children

“…According to a meta-analysis, diagnosing ovarian torsion is tricky, with a median delay of 100 h [ 8 ]. Recent trends focused on the value of ultrasound and Doppler imaging emergencies [ 9 , 10 , 11 ]. Ultrasound has 70% and 87% sensitivity and specificity, respectively, which may help with diagnosis [ 11 ].…”

Pediatric Ovarian Torsion on Point-of-Care Ultrasound

“…Ovarian torsion occurs rarely, with an estimated incidence of 4.9 per 100,000 children, 1 but comprises up to 4% of pediatric emergency department (PED) visits for acute abdominal pain 2 . Missed diagnosis can result in ovarian necrosis and peritonitis 3 . The clinical signs of ovarian torsion are nonspecific, and the presence of blood flow on sonography does not rule out torsion 4 .…”