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Added value of gadolinium-based contrast agents for magnetic resonance evaluation of adnexal torsion in girls

Abdominal Radiology volume 47, pages 3868–3882 (2022)Cite this article

Abstract

Purpose

Ultrasound is the first-line imaging modality to evaluate adnexa in girls with clinical suspicion of torsion. Patients with equivocal ultrasound findings can undergo MRI for better delineation of adnexal pathology. Here, we assess the utility of intravenous contrast in MRI evaluation of adnexal torsion in children.

Methods

Two pediatric radiologists (R1, R2) retrospectively reviewed 198 pelvic MRI exams in 172 girls (median age 15 years). Each MRI was reviewed twice. The first review included pre-contrast images only. A second review, at least 1 month later, included both pre- and post-contrast images. Readers concluded if findings were suspicious for torsion or not. Readers’ findings were compared to each other’s and to surgical and MRI reports and clinical course.

Results

198 MRI exams yielded 354 evaluable ovaries. Surgical and pathological reports were available for 47 patients. 11 patients had adnexal torsion. Both readers accurately diagnosed acutely torsed ovaries during pre- and post-contrast reviews (n = 4). However, readers disagreed on torsed paraovarian cysts (n = 4) and chronically/intermittently torsed ovaries (n = 3). In 21 non-torsed ovaries that had lesions, one or both readers concluded that there were pre-contrast features of torsion. In this set with ovarian lesions, contrast helped readers to correctly conclude no torsion (R1 = 8, R2 = 6) more commonly than to incorrectly conclude torsion (1 each), improving post-contrast specificity for each reader.

Conclusions

Post-contrast sequences did not provide additional benefit in evaluating acutely torsed ovaries but helped in excluding torsion in patients with adnexal lesions. Therefore, contrast administration should be individualized, potentially reserved only for those with abnormal ultrasound or pre-contrast images.

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Abbreviations

DWI:

Diffusion weighted imaging

GBCAs:

gadolinium-based contrast agents

Gd:

Gadolinium

HIPAA:

Health insurance portability and accountability act

IRB:

Institutional review board

MRI:

Magnetic resonance imaging

US:

Ultrasound

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Acknowledgements

We thank Johnny Mclaughlin (Radiology Systems Analyst) and Andrew Longoria (PACS Administrator) from the Department of Radiology of the Children’s Hospital of Philadelphia for facilitating retrieval, anonymization, and review of MRI images.

Funding

No financial support was granted for this study.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA

    Mohamed M. Elsingergy, Edward R. Oliver, Hansel J. Otero & Susan J. Back

  2. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Edward R. Oliver, Hansel J. Otero & Susan J. Back

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  1. Mohamed M. Elsingergy
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  2. Edward R. Oliver
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Contributions

SJB and HJO: Study concepts and study design; MME, SJB, and HJO: Literature research; SJB and ERO: Data collection; all authors: Inter-rater reliability; MME, SJB, and HJO: Data analysis/interpretation; MME and SJB: Statistical analysis. Manuscript drafting and revision for important intellectual content was done by all authors; manuscript final version approval was done by all authors.

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Correspondence to Mohamed M. Elsingergy.

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Elsingergy, M.M., Oliver, E.R., Otero, H.J. et al. Added value of gadolinium-based contrast agents for magnetic resonance evaluation of adnexal torsion in girls. Abdom Radiol 47, 3868–3882 (2022). https://doi.org/10.1007/s00261-022-03642-x

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  • DOI: https://doi.org/10.1007/s00261-022-03642-x

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