Skip to main content
SpringerLink
Log in

Predicting necrosis in adnexal torsion in women of reproductive age using magnetic resonance imaging

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To identify the diagnostic performance of magnetic resonance (MR) imaging for patients with adnexal torsion and to develop a predictive model for necrosis related to torsion.

Methods

The institutional ethics committee approved this retrospective study. A total of 56 women with a preoperative pelvic MR scan and a surgical and pathologic diagnosis of adnexal torsion were enrolled from five institutions. Three radiologists reviewed the MR images independently. The kappa value of interrater agreement was assessed. Differences between patients treated with conservative surgery and adnexectomy were evaluated by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the model to predict ovarian necrosis.

Results

Fifty-six patients were divided into the conservative surgery group (24/56, 42.9%) or the adnexectomy group (32/56, 57.1%) depending on the surgical outcomes. The radiographic features related to torsion were interpreted by three raters retrospectively with substantial interrater agreement (kappa > 0.60). Older reproductive age and pedicle hemorrhagic infarction were significantly associated with adnexectomy (p < 0.05). At multivariate analysis, pedicle hemorrhagic infarction (odds ratio = 10.476 [95% confidence interval 1.103, 99.504; p = 0.041]) was associated with adnexectomy. Using the predictive model (older reproductive age and pedicle hemorrhagic infarction), a receiver operating characteristic curve was generated with an area under the curve (AUC = 0.870 ± 0.049).

Conclusion

The presence of pedicle hemorrhagic infarction and older reproductive age can predict necrosis of adnexal torsion and may be used to guide the optimal treatment strategy.

Key Points

• Pedicle hemorrhagic infarction and older reproductive age are predictors of necrosis in adnexal torsion in patients of reproductive age (AUC = 0.870 ± 0.049).

• Cystic wall thickening, enlarged vascular pedicle, tubal thickening, and uterine deviation are associated with a high risk for adnexal torsion, occurring in more than half of the cases in this study.

• MR findings are useful for the definitive diagnosis of adnexal torsion and for the prediction of adnexal necrosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the curve

CI:

Confidence interval

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

FS:

Fat suppression

IQR:

Interquartile range

MR:

Magnetic resonance

ROC:

Receiver operating characteristic

TSE:

Turbo spin-echo sequences

US:

Ultrasonography

References

  1. Hibbard LT (1985) Adnexal torsion. Am J Obstet Gynecol 152:456–461

    Article  CAS  Google Scholar 

  2. Sasaki KJ, Miller CE (2014) Adnexal torsion: review of the literature. J Minim Invasive Gynecol 21:196–202

    Article  Google Scholar 

  3. Nair S, Joy S, Nayar J (2014) Five year retrospective case series of adnexal torsion. J Clin Diagn Res 8:OC09–OC13

    PubMed  PubMed Central  Google Scholar 

  4. Huchon C, Staraci S, Fauconnier A (2010) Adnexal torsion: a predictive score for pre-operative diagnosis. Hum Reprod 25:2276–2280

    Article  Google Scholar 

  5. Huchon C, Panel P, Kayem G, Schmitz T, Nguyen T, Fauconnier A (2012) Does this woman have adnexal torsion? Hum Reprod 27:2359–2364

    Article  Google Scholar 

  6. Padovan RS, Kralik M, Prutki M, Hrabak M, Oberman B, Potocki K (2008) Cross-sectional imaging of the pelvic tumors and tumor-like lesions in gynecologic patients-misinterpretation points and differential diagnosis. Clin Imaging 32:296–302

    Article  Google Scholar 

  7. Mohan S, Thomas M, Raman J (2014) Adnexal torsion: clinical, radiological and pathological characteristics in a tertiary care centre in Southern India. Int J Reprod Contracept Obstet Gynecol. https://doi.org/10.5455/2320-1770.ijrcog20140968:703-708

  8. Wilkinson C, Sanderson A (2012) Adnexal torsion - a multimodality imaging review. Clin Radiol 67:476–483

    Article  CAS  Google Scholar 

  9. Beranger-Gibert S, Sakly H, Ballester M et al (2016) Diagnostic value of MR imaging in the diagnosis of adnexal torsion. Radiology 279:461–470

    Article  Google Scholar 

  10. Savelli L, Ghi T, De Iaco P, Ceccaroni M, Venturoli S, Cacciatore B (2006) Paraovarian/paratubal cysts: comparison of transvaginal sonographic and pathological findings to establish diagnostic criteria. Ultrasound Obstet Gynecol 28:330–334

    Article  CAS  Google Scholar 

  11. Moribata Y, Kido A, Yamaoka T et al (2015) MR imaging findings of ovarian torsion correlate with pathological hemorrhagic infarction. J Obstet Gynaecol Res 41:1433–1439

    Article  Google Scholar 

  12. Kato H, Kanematsu M, Uchiyama M, Yano R, Furui T, Morishige K (2014) Diffusion-weighted imaging of ovarian torsion: usefulness of apparent diffusion coefficient (ADC) values for the detection of hemorrhagic infarction. Magn Reson Med Sci 13:39–44

    Article  Google Scholar 

  13. Rha SE, Byun JY, Jung SE et al (2002) CT and MR imaging features of adnexal torsion. Radiographics 22:283–294

    Article  Google Scholar 

  14. Foti PV, Ognibene N, Spadola S et al (2016) Non-neoplastic diseases of the fallopian tube: MR imaging with emphasis on diffusion-weighted imaging. Insights Imaging 7:311–327

    Article  Google Scholar 

  15. Landis JR, Koch GG (1977) An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 33:363–374

    Article  CAS  Google Scholar 

  16. Swenson DW, Lourenco AP, Beaudoin FL, Grand DJ, Killelea AG, McGregor AJ (2014) Ovarian torsion: case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. Eur J Radiol 83:733–738

    Article  Google Scholar 

  17. Grunau GL, Harris A, Buckley J, Todd NJ (2018) Diagnosis of ovarian torsion: is it time to forget about Doppler? J Obstet Gynaecol Can 40:871–875

    Article  Google Scholar 

  18. Ben-Ami M, Perlitz Y, Haddad S (2002) The effectiveness of spectral and color Doppler in predicting ovarian torsion. A prospective study. Eur J Obstet Gynecol Reprod Biol 104:64–66

    Article  Google Scholar 

  19. Ito K, Utano K, Kanazawa H et al (2015) CT prediction of the degree of ovarian torsion. Jpn J Radiol 33:487–493

    Article  Google Scholar 

  20. Fujii S, Kaneda S, Kakite S et al (2011) Diffusion-weighted imaging findings of adnexal torsion: initial results. Eur J Radiol 77:330–334

    Article  Google Scholar 

  21. Jung SI, Park HS, Jeon HJ et al (2016) CT predictors for selecting conservative surgery or adnexectomy to treat adnexal torsion. Clin Imaging 40:816–820

    Article  Google Scholar 

  22. Naiditch JA, Barsness KA (2013) The positive and negative predictive value of transabdominal color Doppler ultrasound for diagnosing ovarian torsion in pediatric patients. J Pediatr Surg 48:1283–1287

    Article  Google Scholar 

  23. Tsafrir Z, Hasson J, Levin I, Solomon E, Lessing JB, Azem F (2012) Adnexal torsion: cystectomy and ovarian fixation are equally important in preventing recurrence. Eur J Obstet Gynecol Reprod Biol 162:203–205

    Article  Google Scholar 

  24. Melcer Y, Sarig-Meth T, Maymon R, Pansky M, Vaknin Z, Smorgick N (2016) Similar but different: a comparison of adnexal torsion in pediatric, adolescent, and pregnant and reproductive-age women. J Womens Health (Larchmt) 25:391–396

    Article  Google Scholar 

  25. Gu X, Yang M, Liu Y, Liu F, Liu D, Shi F (2018) The ultrasonic whirlpool sign combined with plasma d-dimer level in adnexal torsion. Eur J Radiol 109:196–202

    Article  Google Scholar 

  26. Patil AR, Nandikoor S, Rao A et al (2015) Multimodality imaging in adnexal torsion. J Med Imaging Radiat Oncol 59:7–19

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Yanan Cui for providing both guidance and technical support; Dr. Changyu Zhou, Dr. Qingzhu Li, and Dr. Jinxia Zhen for the help with the data collection; and Mrs. Brigitte Pocta for providing writing assistance.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, The Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Qinhuai District, Nanjing City, Jiangsu Province, China

    Na Duan, Xiao Chen & Zhongqiu Wang

  2. Department of Radiology, Ruijin Hospital North of the Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Min Rao

  3. Department of Gynecology and Reproductive Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China

    Yanyun Yin

  4. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, MD, USA

    Rong Chen

Authors
  1. Na Duan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Min Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiao Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yanyun Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhongqiu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rong Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhongqiu Wang.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Zhongqiu Wang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Rong Chen provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective study

• Case-control study

• Data from five institutions

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duan, N., Rao, M., Chen, X. et al. Predicting necrosis in adnexal torsion in women of reproductive age using magnetic resonance imaging. Eur Radiol 30, 1054–1061 (2020). https://doi.org/10.1007/s00330-019-06434-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-019-06434-y

Keywords

Search

Navigation