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Pillot R, Hossu G, Cherifi A, Guillez K, Morel O, Beaumont M, Fijean AL, Bertholdt C. Contribution of contrast-enhanced ultrasound in the diagnosis of adnexal torsion (AGATA): protocol for a prospective comparative study. BMJ Open 2023; 13:e073301. [PMID: 37620263 PMCID: PMC10450051 DOI: 10.1136/bmjopen-2023-073301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Adnexal torsion is a surgical emergency and its prognosis depends on the time elapsed prior to treatment. The diagnosis relies on pelvic ultrasound in which sensitivity remains low and may lead to misdiagnosis.The primary objective is to evaluate the diagnostic performance of contrast-enhanced ultrasound for the diagnosis of adnexal torsion in women with suspected adnexal torsion. The secondary objectives are: (1) to describe the perfusion parameters of the ovaries by contrast-enhanced ultrasound, (2) to compare diagnostic performance of contrast ultrasound with bidimensional (2D) Doppler for the detection of adnexal torsion, (3) to describe the perfusion parameters of the ovarian as a function of the degree of adnexal torsion, (4) to compare perfusion parameters before and after ovarian detorsion and (5) to describe perfusion parameters of the ovarian by using MicroVascular Flow technique. METHODS AND ANALYSIS This is a monocentric, prospective comparative, non-randomised, open and interventional study. We hypothesise to include 30 women: 20 positive cases compared with 10 control cases. Women are informed and recruited in the emergency ward, over a period of 36 months.The primary endpoint is the signal intensity measurement to assess sensitivity, specificity, positive and negative predictive values of contrast-enhanced ultrasound for detection of adnexal torsion in women with suspected adnexal torsion. The presence or absence of adnexal torsion is confirmed during the surgical intervention. ETHICS AND DISSEMINATION The study was approved by the French Ethics Committee, the CPP (Comité de Protection des Personnes) OUEST I on 3 July 2020 with reference number 2020T1-16. The results of this study will be published in a peer-reviewed journal and will be presented at relevant conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registry (NCT04522219); EudraCT registry (2020-000993-27).
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Affiliation(s)
- Rémi Pillot
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
| | - Gabriela Hossu
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
- CIC-Innovation Technologique, CHRU Nancy, Vandoeuvre-lès-Nancy, Lorraine, France
| | - Aboubaker Cherifi
- CIC-Innovation Technologique, CHRU Nancy, Vandoeuvre-lès-Nancy, Lorraine, France
| | - Kévin Guillez
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
| | - Olivier Morel
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
| | - Marine Beaumont
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
- CIC-Innovation Technologique, CHRU Nancy, Vandoeuvre-lès-Nancy, Lorraine, France
| | - Anne-Laure Fijean
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
| | - Charline Bertholdt
- CHRU de Nancy, Service de gynécologie obstétrique & néonatologie, Nancy, Lorraine, France
- Laboratoire IADI INSERM U1254, CHRU Nancy, Vandœuvre-lès-Nancy, Lorraine, France
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Yagur Y, Brisker K, Kveler K, Cohen G, Weitzner O, Schreiber H, Schonman R, Klein Z, Biron-Shental T. Can Natural Language Processing Improve Adnexal Torsion Predictions? J Minim Invasive Gynecol 2023; 30:672-677. [PMID: 37119990 DOI: 10.1016/j.jmig.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
STUDY OBJECTIVE To create a decision support tool based on machine learning algorithms and natural language processing (NLP) technology, to augment clinicians' ability to predict cases of suspected adnexal torsion. DESIGN Retrospective cohort study SETTING: Gynecology department, university-affiliated teaching medical center, 2014-2022. PATIENTS This study assessed risk-factors for adnexal torsion among women managed surgically for suspected adnexal torsion based on clinical and sonographic data. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The dataset included demographic, clinical, sonographic, and surgical information obtained from electronic medical records. NLP was used to extract insights from unstructured free text and unlock them for automated reasoning. The machine learning model was a CatBoost classifier that utilizes gradient boosting on decision trees. The study cohort included 433 women who met inclusion criteria and underwent laparoscopy. Among them, 320 (74%) had adnexal torsion diagnosed during laparoscopy, and 113 (26%) did not. The model developed improved prediction of adnexal torsion to 84%, with a recall of 95%. The model ranked several parameters as important for prediction. Age, difference in size between ovaries, and the size of each ovary were the most significant. The precision for the "no torsion" class was 77%, with a recall of 45%. CONCLUSIONS Using machine learning algorithms and NLP technology as a decision-support tool for the diagnosis of adnexal torsion is feasible. It improved true prediction of adnexal torsion to 84% and decreased cases of unnecessary laparoscopy.
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Affiliation(s)
- Yael Yagur
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel.
| | - Karin Brisker
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Ksenya Kveler
- Microsoft Corporation (Brisker, and Dr. Kveler), Herzliya, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Schreiber
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Meir Medical Center, Kfar Saba, Israel; Sackler School of Medicine (Drs. Yagur, Cohen, Weitzner, Schreiber, Schonman, Klein, and Biron), Tel Aviv University, Tel Aviv, Israel
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Garde I, Paredes C, Ventura L, Pascual MA, Ajossa S, Guerriero S, Vara J, Linares M, Alcázar JL. Diagnostic accuracy of ultrasound signs for detecting adnexal torsion: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:310-324. [PMID: 35751902 DOI: 10.1002/uog.24976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard. METHODS This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined. RESULTS The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses. CONCLUSIONS The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- I Garde
- Department of Obstetrics and Gynecology, Hospital Universitario de Cruces, Bilbao, Spain
| | - C Paredes
- Department of Obstetrics and Gynecology, Hospital Materno-Infantil, Badajoz, Spain
| | - L Ventura
- School of Medicine, University of Navarra, Pamplona, Spain
| | - M A Pascual
- Department of Obstetrics, Gynecology, and Reproduction, Institut Universitary Dexeus, Barcelona, Spain
| | - S Ajossa
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - S Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, Monserrato, University of Cagliari, Cagliari, Italy
| | - J Vara
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - M Linares
- Department of Obstetrics and Gynecology, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - J L Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
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Goudie A. Right Iliac Fossa Pain other than Appendicitis: A Pictorial Review. J Med Ultrasound 2023; 31:8-12. [PMID: 37180625 PMCID: PMC10173825 DOI: 10.4103/jmu.jmu_6_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/01/2023] [Indexed: 05/16/2023] Open
Abstract
Right iliac fossa pain is a common presentation. Although appendicitis is the most common surgical emergency, many other pathologies can have similar presentations and should be considered. This review describes the findings and shows examples of conditions other than appendicitis that should be examined for in a patient who presents with right iliac fossa pain, particularly if the appendix is not seen or seen to be normal.
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Affiliation(s)
- Adrian Goudie
- Emergency Department, Fiona Stanley Hospital, Perth, Australia
- Address for correspondence: Dr. Adrian Goudie, Emergency Department, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch 6150, Australia. E-mail:
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Shen L, Tse JR, Negrete LM, Flory MN, Yoon L, Kamaya A. Clinical and ultrasound features of dermoid-associated adnexal torsion. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3583-3593. [PMID: 35809127 DOI: 10.1007/s00261-022-03601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine the clinical and ultrasound features of dermoid-associated adnexal torsion. METHODS Forty-four patients with at least one dermoid and ultrasound ≤ 30 days of surgery were retrospectively reviewed by three radiologists. Ultrasound and clinical findings were compared to intra-operative findings using Fisher's exact test or Mann-Whitney test with p < 0.05 to determine statistical significance.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Correct. No edit RESULTS: Twenty patients had torsion, while 24 patients did not. Patients with dermoid-associated torsion were more likely to present to emergency department (ED) (100% vs 13%; p < 0.001) and have acute unilateral pelvic pain (100% vs 42%; p < 0.001). On ultrasound, patients with torsion had larger dermoids (median largest dimension 9.0 cm (IQR 7.7-11.1) vs 6.0 cm (IQR 4.4-7.5); p < 0.001), displaced dermoid anterior or superior to the uterus (59% vs 21%; p = 0.016), and ipsilateral adnexal fluid (41% vs 4%; p = 0.003). Displaced dermoid and ipsilateral adnexal fluid had substantial (kappa = 0.72) and moderate inter-rater agreement (kappa = 0.49), respectively. The combination of ED presentation and each statistically significant ultrasound feature (dermoid size ≥ 5.0 cm, displaced dermoid, and ipsilateral adnexal fluid) yielded high specificity and positive predictive value (ranging from 93-100% to 92-100%, respectively). The combination of ED presentation and dermoid size ≥ 5.0 cm yielded the highest sensitivity, negative predicative value, and accuracy (100%, 100%, and 96%, respectively).Please check and confirm whether the edit made to the article title is in order.Looks great. No edits. Thank you! CONCLUSION Although the diagnosis of adnexal torsion in the presence of an ovarian dermoid is traditionally challenging, the combination of ED presentation and ultrasound features increase diagnostic confidence of dermoid-associated adnexal torsion.
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Affiliation(s)
- Luyao Shen
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
| | - Justin R Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Lindsey M Negrete
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Marta N Flory
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Luke Yoon
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
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Adnexal torsion: a review of diagnosis and management strategies. Curr Opin Obstet Gynecol 2022; 34:196-203. [PMID: 35895961 DOI: 10.1097/gco.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Adnexal torsion remains a diagnostic challenge heavily reliant on high clinical suspicion, with patient presentation and imaging used as adjuncts to aid in its diagnosis. This review summarizes diagnostic and management techniques of adnexal torsion to assist providers when encountering this surgical emergency. RECENT FINDINGS Common findings of adnexal torsion include abdominal pain, nausea, vomiting, and adnexal mass or ovarian enlargement. An elevated neutrophil to lymphocyte ratio may be useful for diagnosis. A 'whirlpool' sign, 'follicular ring' sign, enlarged/edematous ovary, and absent Doppler flow to the ovary are highly suggestive of adnexal torsion. Intraoperative visual diagnosis of ovarian death is highly inaccurate, with only 18-20% of ovaries necrotic on pathological examination. Necrotic appearing ovaries have been shown to have follicular activity on ultrasound one year postoperatively. SUMMARY Pelvic ultrasound remains the first-line imaging modality. In patients of reproductive age, we recommend performing detorsion with ovarian conservation, even in cases where the tissue appears necrotic, given poor intraoperative diagnostic rates of tissue death. Retention of ovarian function is also reliant on a timely diagnosis and intervention. We emphasize that the risk of ovarian damage/loss outweigh the risk of a diagnostic laparoscopy in patients of reproductive age.
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Scheier E. Diagnosis and Management of Pediatric Ovarian Torsion in the Emergency Department: Current Insights. Open Access Emerg Med 2022; 14:283-291. [PMID: 35770141 PMCID: PMC9236466 DOI: 10.2147/oaem.s342725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/17/2022] [Indexed: 11/23/2022] Open
Abstract
Ovarian torsion is defined as twisting of the ovary around an axis consisting of its vascular pedicle, the infundibulopelvic ligament and the tubo-ovarian ligament, and can occur in females of any age. Torsion can be a result of ovarian mass causing asymmetry and subsequent torsion, or can be spontaneous. While ovarian torsion is a surgical emergency, early diagnosis and treatment can preserve ovarian viability even if necrosis is seen operatively. Presentation classically involves sudden onset severe abdominal pain and vomiting but diagnostic delay can follow subtler presentations. Diagnosis is most commonly based on sonographic findings, but advanced imaging such as CT or MRI may be required if sonography is not diagnostic. Treatment is surgical, with ovarian preservation preferred in almost all cases. In this review, I present the most recent evidence on epidemiology, diagnosis, and management of pediatric ovarian torsion, with a focus on point-of-care ultrasound for the emergency care provider.
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Affiliation(s)
- Eric Scheier
- Pediatric Emergency Department, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Chen Y, Liu M, Zhang M, Yang M, Weng Z, Wu Q, He S. Ultrasonographic scoring system for the diagnosis of adnexal torsion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:525-531. [PMID: 35244941 DOI: 10.1002/jcu.23178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE To establish the utility of an ultrasonographic scoring system for the diagnosis of adnexal torsion. METHODS We retrospectively analyzing 358 adnexal torsion cases. Using Pearson's χ2 test we determined whether ultrasonographic signs were significantly associated with adnexal torsion. Receiver operating characteristic curves were used to evaluate the diagnostic efficacy of the system. Ultimately by using binary logistic regression we established a precise and convenient scoring system. RESULTS The torsion score was based on five criteria that were identified to be independently associated with adnexal torsion: (1) abnormal position of the index adnexa (odds ratio [OR], 2.311); (2) presence of a mass or cyst (OR, 3.495); (3) unilateral ovarian enlargement (OR, 3.051); (4) vascular pedicle twisting (OR, 2.105); and (5) peripheral hypervascularity of the corpus luteum with ovarian edema(encapsulating cyst sign) (OR, 4.164).patients with torsion who scored 0, have a predicted diagnosis rate of 20.9%; patients whose scores were 1,2 have a predicted probability of 41.8% and 66.15%, respectively. For patients with torsion scores of 3, 4, and 5, predicted diagnosis rates were 84.16%, 93.52%, and 98.27%, respectively. CONCLUSION The ultrasonographic scoring system is feasible and precisely diagnoses adnexal torsion using ultrasound.
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Affiliation(s)
- Yan Chen
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Min Liu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Meilian Zhang
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Minmin Yang
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Zongjie Weng
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qiumei Wu
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Suhui He
- Department of Ultrasound, Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Characteristics and Risk Factors for Ischemic Ovary Torsion in Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020206. [PMID: 35204926 PMCID: PMC8869959 DOI: 10.3390/children9020206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 01/02/2023]
Abstract
Identifying ischemic ovary as a complication of ovary torsion (OT) is a significant challenge in children. This study identified risk factors for ischemic OT among pediatric OT patients to prevent delayed treatment. This retrospective study included pediatric inpatients who underwent operation for OT over 20 years. We employed multivariable logistic regression to find the risk factors associated with ischemic OT. Among the 118 patients included in this study, 78 (66.1%) had ischemic OT. Patients with ischemic OT tended to be younger; had more frequent vomiting; and had elevated White blood cell (WBC), C-Reactive protein (CRP), and segments in comparison with non-ischemic OT patients. Multivariable regression showed increased odds of ischemic ovary torsion, associated with higher WBC (12.3 × 103/mm3 vs. 8.7 × 103/mm3, p < 0.001), CRP (50.4 mg/L vs. 8.4 mg/L, p < 0.001), and vomiting (55.1% vs. 25%, p = 0.002) than in non-ischemic patients. A receiver-operating characteristic (ROC) analysis indicated that patients with vomiting, leukocytosis, or CRP ≧ 40 mg/L were more likely to have ischemic OT (sensitivity, 92%; specificity, 54%; PPV, 79.6; NPV, 78.9%). Ischemic OT is common among pediatric OT patients. The presence of potential risk factors of vomiting, leukocytosis, and CRP more significant than 40 mg/L may assist clinicians in ensuring an expedited surgical treatment.
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Dighe M. Invited Commentary: Adnexal Torsion-Seven Tips to Not Miss the Diagnosis at Imaging. Radiographics 2021; 41:E57-E59. [PMID: 33646905 DOI: 10.1148/rg.2021210002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Manjiri Dighe
- From the Department of Radiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
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