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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:7-13 • 0278-4297

Preoperative Sonographic and Clinical Characteristics as Predictors of Ovarian Torsion

Libby L. Shadinger, MD, Rochelle F. Andreotti, MD and Rachel L. Kurian, MD

Departments of Radiology and Radiological Sciences (L.L.S., R.F.A.) and Obstetrics and Gynecology (R.F.A., R.L.K.), Vanderbilt University Medical Center, Nashville, Tennessee USA.

Address correspondence to Rochelle F. Andreotti, MD, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave S, Nashville, TN 37232-2675. E-mail: rochelle.f.andreotti{at}vanderbilt.edu

Objective. The purpose of this study was to determine the most closely associated sonographic and clinical characteristics of ovarian torsion. Methods. The medical records and sonographic studies of 39 patients with pathologically proven ovarian torsion diagnosed at our institution from July 1, 2000, through December 31, 2005, were retrospectively reviewed. The volumes of the affected ovaries and ovary/mass complexes were compared with an age-appropriate standard. Statistical significance of the data was assessed by a likelihood ratio {chi}2 analysis. Results. All patients (100%) had a chief symptom of abdominal pain. Thirty-three (85%) reported vomiting; 22 (56%) had leukocytosis; and 7 (18%) had a documented elevated temperature. All affected ovaries and ovary/mass complexes were enlarged. Twenty-one (54%) had arterial flow on Doppler interrogation, and 18 (46%) had no arterial flow. Thirteen (33%) had venous flow, and 26 (67%) had no venous flow. Differences in the arterial and venous flow patterns between the premenarchal and reproductive age groups were not statistically significant. Conclusions. Abdominal pain, vomiting, ovarian enlargement, and absence of ovarian venous Doppler flow are the most frequently shown clinical and sonographic indicators of ovarian torsion. However, ovarian enlargement, even in the presence of arterial and venous Doppler flow, is the most commonly associated sonographic finding. Suspicion of ovarian torsion should be high in the setting of clinical symptoms and ovarian enlargement regardless of the presence or absence of an ovarian Doppler signal.

Key Words: color Doppler sonography • ovarian masses • ovarian torsion

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.