European Radiology

, Volume 30, Issue 2, pp 1054–1061 | Cite as

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

  • Na Duan
  • Min Rao
  • Xiao Chen
  • Yanyun Yin
  • Zhongqiu WangEmail author
  • Rong Chen
Magnetic Resonance



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.


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.


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).


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.


Magnetic resonance imaging Pelvic pain Ovary Necrosis 



Apparent diffusion coefficient


Area under the curve


Confidence interval


Computed tomography


Diffusion-weighted imaging


Fat suppression


Interquartile range


Magnetic resonance


Receiver operating characteristic


Turbo spin-echo sequences





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 information

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

Compliance with ethical standards


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.


• Retrospective study

• Case-control study

• Data from five institutions


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjing CityChina
  2. 2.Department of RadiologyRuijin Hospital North of the Shanghai Jiao Tong University School of MedicineShanghaiChina
  3. 3.Department of Gynecology and Reproductive MedicineThe Affiliated Hospital of Nanjing University of Chinese MedicineNanjingChina
  4. 4.Department of Diagnostic Radiology and Nuclear MedicineUniversity of Maryland Medical CenterBaltimoreUSA

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