Journal of Ultrasound in Medicine, Vol 20, Issue 8 849-854, Copyright © 2001 by American Institute of Ultrasound in Medicine
Subtorsion of the ovary: sonographic features and clinical management
J. Shalev, R. Mashiach, I. Bar-Hava, O. Girtler, J. Bar, D. Dicker and I. Meizner
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tikva, Israel.
OBJECTIVE: To define the sonographic imaging criteria of ovarian
subtorsion. METHODS: Fourteen women 16 to 35 years of age with suspected
unilateral twisted ovaries were sonographically evaluated in a tertiary
care center before laparoscopy. Transvaginal sonography was performed to
determine the longest ovarian dimension, diameter of the periovarian
vessels, and degree of intraovarian blood flow and to evaluate ovarian
morphology. Laparoscopy was performed to verify the sonographic findings
and to perform detorsion. RESULTS: All ovaries with subtorsion were of
normal size, although still significantly longer than the contralateral,
normal ovaries (47.5 and 29.6 mm, respectively; P = .001). The mean
diameter of the periovarian vessels was significantly greater for the
ovaries with subtorsion than the normal ovaries (29.9 and 19.2 mm,
respectively; P= .0001). At laparoscopy, the ovary was twisted less than
180 degrees in 9 patients and 180 degrees to 360 degrees in 5. The degree
of twisting correlated significantly with the size of the ovary (P = .016)
and diameter of the periovarian vessels (P = .046). The 3-month sonographic
follow-up after detorsion revealed bilateral normal ovarian dimensions with
proper follicular growth. CONCLUSIONS: Congestion of the periovarian
vessels with normal ovarian morphology and persistent blood flow on
sonography, combined with the presence of appropriate clinical signs, may
be indicative of ovarian subtorsion.
