THE VALUE OF COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF ADNEXAL TORSION

Hồ Vũ Khôi Nguyễn1, , Doan Thai Duy2, Vo Tan Duc3, Huynh Phuong Hai3
1 Bệnh viện Đại học Y Dược TPHCM
2 Department of Diagnostic Imaging, University of Medicine and Pharmacy Hospital, Ho Chi Minh City
3 Department of Diagnostic Imaging, University of Medicine and Pharmacy, Ho Chi Minh City

Main Article Content

Abstract

Abstract


Objective: To determine the diagnostic value of computed tomography (CT) in detecting adnexal torsion.


Methods: A retrospective, case-control study was conducted, including 110 surgical cases involving the adnexa, among which 55 cases were confirmed to have adnexal torsion. CT imaging findings were recorded and analyzed using the Chi-square test, receiver operating characteristic (ROC) curve analysis, and multivariate logistic regression to assess diagnostic value and develop a diagnostic model for adnexal torsion.


Results: Adnexal torsion predominantly occurred in patients under 50 years old and was more frequently found on the right side. Malignant histopathological results accounted for approximately 8,9%. The CT features associated with adnexal torsion included eccentric wall thickening, whirlpool sign, mass sign, navel sign, crescent sign, hemorrhage, uterine deviation, and non-enhancing tissue (p < 0,05). Among these, the whirlpool sign showed the highest specificity and positive predictive value in diagnosing adnexal torsion (96,4% and 93,6%, respectively). The diagnostic model for adnexal torsion based on four key features –whirlpool sign, mass sign, non-enhancing tissue, and navel sign – demonstrated good performance, with an area under the curve (AUC) of 0,88, sensitivity of 83,6%, and specificity of 89,3%.


Conclusion: CT is a valuable imaging modality for diagnosing adnexal torsion. The diagnostic model based on four key features – whirlpool sign, mass sign, non-enhancing tissue, and pedicle sign – provides significant support in diagnosing the condition.


Keywords: Adnexal torsion, computed tomography, CT.

Article Details

References

1. Hibbard L.T. Adnexal torsion. AJOG. 1985;152(4):456-461. doi:10.1016/s0002-9378(85)80157-5.
2. Dawood M.T., Naik M., Bharwani N., et al. Adnexal torsion: Review of radiologic appearances. Radiographics. 2021;41(2):609-624. doi:10.1148/rg.2021200118.
3. Shaaban A.M. Acute Adnexal Torsion. In: Shaaban A.M., Christine O.M., Marc S.T., et al, eds. Diagnostic Imaging: Gynecology. 3rd ed. Elsevier Health Sciences; 2021:679-684.
4. Ling S.C., Jing L., Zheng Q.Z., et al. Computed tomography features of adnexal torsion: A meta-analysis. Academic Radiology. 2022;29(2):317-325. doi: 10.1016/j.acra.2020.09.025.
5. Caroline M., Verheyden C., Doyon C.F., et al. Diagnostic performance of CT signs for predicting adnexal torsion in women presenting with an adnexal mass and abdominal pain: A case-control study. European Journal of Radiology. 2018;98:75-81. doi:10.1016/j.ejrad.2017.11.004.
6. Lee M.S., Moon M.H., Woo H., et al. CT findings of adnexal torsion: A matched case-control study. PLOS ONE. 2018;13(7):e0200190. doi:10.1371/journal.pone.0200190
7. Jung S.I., Park H.S., Jeon H.J., et al. CT predictors for selecting conservative surgery or adnexectomy to treat adnexal torsion. Clinical Imaging. 2016;40(4):816-820. doi:10.1016/j.clinimag.2016.03.011.
8. Lee J.H., Park S.B., Shin S.H., et al. Value of intra-adnexal and extra-adnexal computed tomographic imaging features diagnosing torsion of adnexal tumor. JCAT. 2009;33(6):872-876. doi:10.1097/RCT.0b013e31819e41f3.
9. Lee S.L., Ku Y.M., Choi B.G., et al. Multidetector-row computed tomography findings of adnexal torsion: An analysis of 116 patients. Diagnostic and Interventional Imaging. 2016;97(9):899-905. doi:10.1016/j.diii.2016.03.004.
10. Duan N., Chen X., Rao M., et al. CT predictive model for torsion angle as a marker for risk of necrosis in patients with adnexal torsion. Clinical Radiology. 2021;76(7):540-546. doi:10.1016/j.crad.2021.02.027.
11. Patil A.R., Nandikoor S., Reddy S.C. CT in the diagnosis of adnexal torsion: A retrospective study. Journal of Obstetrics and Gynaecology. 2020;40(3):388-394. doi:10.1080/01443615.2019.1633514.