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Miranian D, Schwartz A, Jiang C, Ndukwe JK, Caldwell M, Lim C, Marsh EE. Emergency Department Utilization for Adnexal Torsion: An Analysis of the Nationwide Emergency Department Sample from 2006-2018. J Minim Invasive Gynecol 2022; 29:1068-1074. [DOI: 10.1016/j.jmig.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
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Gounder S, Strudwick M. Multimodality imaging review for suspected ovarian torsion cases in children. Radiography (Lond) 2020; 27:236-242. [PMID: 32713824 DOI: 10.1016/j.radi.2020.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Ovarian torsion (OT), although rare, can be described as a complete or partial twist of the ovary with impairment of blood flow. Although occurring at any age, it is more common in children and during pregnancy. Presenting symptoms are non-specific but include either persistent or intermittent acute abdominal pain, making early diagnosis difficult. Delayed diagnosis is associated with an increased need for oophorectomy. The aim of this literature review is to establish the safest and most efficacious imaging strategy for OT by comparing and contrasting evidence for current imaging modalities found in the literature. KEY FINDINGS Characteristically, OT can be identified through a combination of findings some of which includes an enlarged ovary, multiple follicles at the periphery and a "whirlpool" sign. Currently, ultrasound is the preferred primary imaging modality; although computed tomography (CT) and magnetic resonance imaging (MRI) may also be used when findings are equivocal; with MRI being the safer option. CONCLUSION Ultimately, while it is true that ovarian torsion is not a common cause of acute abdominal pain in children, it should always be considered in the differential diagnosis. Prior to selecting an imaging modality; the clinical presentation, age group, possible radiation dose and availability of the modality needs to be considered to ensure the appropriate imaging strategy. IMPLICATIONS FOR PRACTICE With new tools such as scoring systems, B-flow imaging (BFI), diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) currently being explored for possible use in the future, early diagnosis of OT may be attainable. Thus, reducing the likelihood of adverse complications and consequently the need for oophorectomy.
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Affiliation(s)
- S Gounder
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, Victoria, Australia.
| | - M Strudwick
- Centre for Advanced Imaging, University of Queensland, St Lucia, Queensland, Australia
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Rougier E, Mar W, Della Valle V, Morel B, Irtan S, Audureau E, Coulomb-L'Hermine A, Ducou Le Pointe H, Blondiaux E. Added value of MRI for the diagnosis of adnexal torsion in children and adolescents after inconclusive ultrasound examination. Diagn Interv Imaging 2020; 101:747-756. [PMID: 32423620 DOI: 10.1016/j.diii.2020.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to assess the performance of magnetic resonance imaging (MRI) in children and adolescents with suspected adnexal torsion (AT) after inconclusive initial ultrasound examination. MATERIALS AND METHODS Twenty-eight girls with a mean age of 12±4 (SD) years (range: 1 month to 18years) were included. All had clinically suspected AT and inconclusive initial ultrasound findings followed by pelvic MRI as a second-line imaging modality. The final diagnosis was obtained by surgery or follow-up. Two radiologists blinded to the clinical, ultrasound and surgical data, retrospectively and independently reviewed MRI examinations. Clinical and MRI features associated with AT were searched for using univariate analyses. RESULT Among the 28 patients, 10/28 patients (36%) had AT and 22/28 (79%) had an ovarian or tubal mass. AT was associated with an age<13years (OR: 10.7; 95% CI: 1.3-148.2) (P=0.022) and a whirlpool sign at MRI (OR: 61.0; median unbiased estimate, 7.2) (P<0.0001). When a mass was present, the best quantitative MRI criteria for AT were mass volume and ovary-corrected volume≥30cm3 (κ=0.72 and 0.61, respectively), mass axis length≥5cm (κ=0.90), and mass surface area≥14 cm2 (κ=0.58), with moderate to almost perfect interobserver agreement. The overall sensitivity, specificity and accuracy of MRI for the diagnosis of AT were 100% (10/10; 95% CI: 69-100), 94% (17/18; 95% CI: 73-100) and 96% (27/28; 95% CI: 82-100) respectively, with perfect interobserver agreement (κ=1). CONCLUSION In pediatric patients with suspected AT and inconclusive initial ultrasound examination, a strategy including MRI as a second-line imaging modality should be considered if MRI does not delay a potential surgery.
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Affiliation(s)
- E Rougier
- Department of Imaging, Hôpital Trousseau, Hôpitaux Universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
| | - W Mar
- Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - V Della Valle
- Department of Imaging, Hôpital Trousseau, Hôpitaux Universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
| | - B Morel
- Department of Imaging, Hôpital Trousseau, Hôpitaux Universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
| | - S Irtan
- Department of Surgery, Hôpital Trousseau, Hôpitaux Universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
| | - E Audureau
- Biostatistic and Epidemiology Department, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, LIC EA 4393, Université Paris-Est Créteil, 91000 Créteil, France
| | - A Coulomb-L'Hermine
- Department of Pathology, Hôpital Trousseau, Hôpitaux Universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
| | - H Ducou Le Pointe
- Department of Imaging, Hôpital Trousseau, Hôpitaux Universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
| | - E Blondiaux
- Department of Imaging, Hôpital Trousseau, Hôpitaux Universitaires de l'Est Parisien, Assistance publique-Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France.
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Adeyemi-Fowode O, McCracken KA, Todd NJ. Adnexal Torsion. J Pediatr Adolesc Gynecol 2018; 31:333-338. [PMID: 29653167 DOI: 10.1016/j.jpag.2018.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 12/17/2022]
Abstract
Adnexal torsion is an uncommon gynecologic disorder caused by the partial or complete rotation of the ovary and/or the fallopian tube on its vascular support. Delay in treatment can impact fertility adversely. The objective of this report is to provide clinical recommendations based on the latest evidence. Specifically we discuss epidemiology, clinical presentation, diagnostic approach and management of adnexal torsion in adolescents.
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Affiliation(s)
- Oluyemisi Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
| | - Kate A McCracken
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio
| | - Nicole J Todd
- Division of General Gynaecology and Obstetrics, University of British Columbia, Vancouver, British Columbia, Canada
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