Over Torsiyonunda Ultrasonografi, Bilgisayarlı Tomografi ve Manyetik Rezonans Görüntüleme Yöntemlerinin Tanısal Değeri

Abstract

Amaç: Over torsiyonu tanısında kullanılan değişik görüntüleme yöntemlerinin tanısal güvenirlik ve doğruluğunu saptamak. Yöntem: Şubat 2010-Eylül 2018 tarihleri arasında over torsiyonu şüphesi ile tedavi edilen hastaların kayıtları retrospektif olarak tarandı. Hastaların gri skala ve renkli doppler ultrasonografi inceleme sonuçları torsiyon ile uyumlu ya da uyumsuz olarak kategorize edildi. Bilgisayarlı tomografi ve manyetik rezonans görünteleme tetkikleri deneyimli iki radyolog tarafından değerlendirilerek torsiyon var veya torsiyon yok şeklinde kesin bir karara varmaları istendi. Değişik görüntüleme yöntemlerinin tanısal güç değerlendirilmesi için duyarlılık, özgüllük, pozitif ve negatif prediktif değer, doğruluk analizleri yapıldı. Testler arası uyumu değerlendirmek için Cohen Kappa analizi kullanıldı. Bulgular: Over torsiyonu tanısıyla yatırılan 127 hastadan 91 kişi (%71,7) opere edildi. Toplamda 69 cerrahi ile kesin tanısı konmuş torsiyon hastası mevcuttu. 120 hastaya tanı için gri skala ve doppler ultrasonografi, 23 hastaya manyetik rezonans görüntüleme ve 20 hastaya bilgisayarlı tomografi işlemi gerçekleştirildi. 94 hasta için görüntüleme yöntemlerinden sadece bir tanesi kullanılırken, 30 hastada iki yöntem ve 3 hastada da üç yöntem aynı anda kullanıldı. Duyarlılık, özgüllük, pozitif prediktif değer, negatif prediktif değer ve doğruluk oranları sırasıyla ultrasonografi için %79,3, %84,2, %84,8, %78,7, %81,7, bilgisayarlı tomografi için %76,9, %85,1, %90,9, %66,7, %80, manyetik rezonans görüntüleme için %80, %66,6, %94,1, %33,3, %78,2 olarak bulundu. Görüntüleme yöntemleri arası uyum düşük örneklem sayısı sebebiyle net değerlendirilemedi. Sonuç: Bu çalışmada ultrasonografi ile literatüre oranla daha iyi ve bilgisayarlı tomografi ve manyetik rezonans görüntüleme ile benzer güvenilirlik ve doğrulukta sonuçlar elde edilmiştir.

Keywords

• Over torsiyonu
• Ultrasonografi
• Bilgisayarlı tomografi
• Manyetik rezonans görüntüleme
• Tanı

Diagnostic Value of Ultrasonography, Computed Tomography and Magnetic Resonance Imaging Methods in Ovarian Torsion

Abstract

Objective: To determine the diagnostic reliability and accuracy of various imaging methods used in the diagnosis of ovarian torsion. Methods: The medical records of patients treated for suspected ovarian torsion between February 2010 and September 2018 were retrospectively screened. The results of grey scale and color doppler ultrasonography examinations were categorized as compatible or incompatible with torsion. Computed tomography and magnetic resonance images were evaluated by two experienced radiologists and asked to come to a final decision as torsion or not. Sensitivity, specificity, positive and negative predictive value, accuracy analyses were performed for diagnostic performance of different imaging methods. Cohen Kappa analysis was used to assess compatibility between tests. Results: Of the 127 patients diagnosed with ovarian torsion, 91 patients (71.7%) underwent surgery. Totally 69 surgically confirmed torsion patients were present. 120 patients underwent grey scale and doppler ultrasonography for diagnosis, 23 patients underwent magnetic resonance examination, and 20 patients underwent computed tomography scans. Only one of the imaging methods was used for 94 patients, while two methods were used in 30 patients and all three methods were used simultaneously in 3 patients. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were 79.3%, 84.2%, 84.8%, 78.7%, 81.7% for ultrasonography 76.9%, 85.1%, 90.9%, 66.7%, 80% for computed tomography and 80%, 66.6%, 94.1%, 33.3%, 78.2% for magnetic resonance imaging respectively. Compatibility between imaging methods could not be evaluated clearly due to the low sample count. Conclusion: In this study, better results than the literature with ultrasonography and similar results with computed tomography and magnetic resonance imaging in terms of reliability and accuracy were obtained.

Keywords

• Ovarian torsion
• ultrasonography
• computed tomography
• magnetic resonance imaging
• diagnosis

References

1. Hiller N, Appelbaum L, Simanovsky N, Lev-Sagi A, Aharoni D, Sella T. CT features of adnexal torsion. Am J Roentgenol 2007;189(1):124-129. doi: 10.2214/AJR.06.0073.
2. WhiteM, Stella J. Ovarian torsion: 10-year perspective. Emerg Med Australas 2005;17(3):231-237. doi: 10.1111/j.1742-6723.2005.00728.x.
3. Sasaki KJ, Miller CE. Adnexal torsion: review of the literature. J Minim Invasive Gynecol 2014;21(2):196-202. doi: 10.1016/j.jmig.2013.09.010.
4. Rha SE, Byun JY, Jung SE, et al. CT and MR imaging features of adnexal torsion. Radiographics 2002;22(2):283-294. doi: 10.1148/radiographics.22.2.g02mr02283.
5. Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 2008;28(5):1355-1368. doi: 10.1148/rg.285075130.
6. Chiou SY, Lev-Toaff AS, Masuda E, Feld RI, Bergin D. Adnexal torsion: new clinical and imaging observations by sonography, computed tomography, and magnetic resonance imaging. J Ultrasound Med 2007;26(10):1289-1301. doi: 10.7863/jum.2007.26.10.1289.
7. Chang KH, Hwang KJ, Kwon HC, et al. Conservative therapy of adnexal torsion employing color Doppler sonography. J Am Assoc Gynecol Laparosc 1998;5(1):13-17. doi: 10.1016/s1074-3804(98)80004-2.
8. Moore C, Meyers AB, Capotasto J, Bokhari J. Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema. Emerg Radiol 2009;16(2):115-120. doi: 10.1007/s10140-008-0754-x.

9. Béranger-Gibert S, Sakly H, Ballester M, et al. Diagnostic value of MR imaging in the diagnosis of adnexal torsion. Radiology 2016;279(2):461-470. doi: 10.1148/radiol.2015150261.
10. Oltmann SC, Fischer A, Barber R, Huang R, Hicks B, Garcia N. Cannot exclude torsion - a 15-year review. J Pediatr Surg 2009;44(6):1212-1216;discussion 1217. doi: 10.1016/j.jpedsurg.2009.02.028.
11. Hasson J, Tsafrir Z, Azem F, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. Am J Obstet Gynecol 2010;202(6):536.e1-6. doi: 10.1016/j.ajog.2009.11.028.
12. Cornfeld D, Scoutt L. Torsion of a hyperstimulated ovary during pregnancy: a potentially difficult diagnosis. Emerg Radiol 2007;14(5):331-335. doi: 10.1007/s10140-007-0607-z.
13. Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol 2005;105(5 Pt 1): 1098-1103. doi: 10.1097/01.AOG.0000157465.99639.e5.
14. Hasiakos D, Papakonstantinou K, Kontoravdis A, Gogas L, Aravantinos L, Vitoratos N. Adnexal torsion during pregnancy: report of four cases and review of the literature. J Obstet Gynaecol Res 2008;34(4 Pt 2):683-687. doi: 10.1111/j.1447-0756.2008.00907.x.
15. Albayram F, Hamper UM. Ovarian and adnexal torsion: spectrum of sonographic findings with pathologic correlation. J Ultrasound Med 2001;20(10):1083-1089. doi: 10.7863/jum.2001.20.10.1083.
16. Pena JE, Ufberg D, Cooney N, Denis AL. Usefulness of Doppler sonography in the diagnosis of ovarian torsion. Fertil Steril 2000;73(5):1047-1050. doi: 10.1016/s0015-0282(00)00487-8.
17. Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med 2004;23(12):1643-1649, quiz 50-51. doi: 10.7863/jum.2004.23.12.1643.
18. Lourenco AP, Swenson D, Tubbs RJ, Lazarus E. Ovarian and tubal torsion: imaging findings on US, CT, and MRI. Emerg Radiol 2014;21(2):179-187. doi: 10.1007/s10140-013-1163-3.
19. Mashiach R, Melamed N, Gilad N, Ben-Shitrit G, Meizner I. Sonographic diagnosis of ovarian torsion: accuracy and predictive factors. J Ultrasound Med 2011;30(9):1205-1210. doi: 10.7863/jum.2011.30.9.1205.
20. Wilkinson C, Sanderson A. Adnexal torsion-a multimodality imaging review. Clin Radiol 2012;67(5):476-483. doi: 10.1016/j.crad.2011.10.018.
21. Bar-On S, Mashiach R, Stockheim D, et al. Emergency laparoscopy for suspected ovarian torsion: are we too hasty to operate? Fertil Steril 2010;93(6):2012-2015. doi: 10.1016/j.fertnstert.2008.12.022.
22. Cohen SB, Weisz B, Seidman DS, Mashiach S, Lidor AL, Goldenberg M. Accuracy of the preoperative diagnosis in 100 emergency laparoscopics performed due to acute abdomen in nonpregnant women. J Am Assoc Gynecol Laparosc 2001;8(1):92-94. doi: 10.1016/s1074-3804(05)60555-5.
23. Kilickesmez O, Tasdelen N, Yetimoglu B, Kayhan A, Cihangiroglu M, Gurmen N. Diffusion-weighted imaging of adnexal torsion. Emerg Radiol 2009;16(5):399-401. doi: 10.1007/s10140-008-0767-5.
24. Fujii S, Kaneda S, Kakite S, et al. Diffusion-weighted imaging findings of adnexal torsion: initial results. Eur J Radiol 2011;77(2):330-334. doi: 10.1016/j.ejrad.2009.07.040.
25. Kato H, Kanematsu M, Uchiyama M, Yano R, Furui T, Morishige K. Diffusion-weighted imaging of ovarian torsion: usefulness of apparent diffusion coefficient (ADC) values for the detection of hemorrhagic infarction. Magn Reson Med Sci 2014;13(1):39-44. doi: 10.2463/mrms.2013-0039.
26. Bekci T, Polat AV, Aslan K, Tomak L, Ceyhan Bilgici M, Danaci M. Diagnostic performance of diffusion-weighted MRI in the diagnosis of ovarian torsion: comparison of torsed and nonaffected ovaries Clinical Imaging 2016;40(5):1029-1033. doi: 10.1016/j.clinimag.2016.06.003.
27. Petkovska I, Duke E, Martin DR, et al. MRI of ovarian torsion: correlation of imaging features with the presence of perifollicular hemorrhage and ovarian viability. Eur J Radiol 2016;85(11):2064-2071. doi: 10.1016/j.ejrad.2016.09.020.
28. Fujii S, Kakite S, Nishihara K, et al. Diagnostic accuracy of diffusion-weighted imaging in differentiating benign from malignant ovarian lesions. J Magn Reson Imaging 2008;28(5):1149-1156. doi: 10.1002/jmri.21575.
29. Gross M, Blumstein SL, Chow LC. Isolated fallopian tube torsion: a rare twist on a common theme. AJR Am J Roentgenol 2005;185(6):1590-1592. doi: 10.2214/AJR.04.1646.
30. Harmon JC, Binkovitz LA, Binkovitz LE. Isolated fallopian tube torsion: sonographic and CT features. Pediatr Radiol 2008;38(2):175-179. doi: 10.1007/s00247-007-0683-y.
31. Kisku S, Thomas RJ. An uncommon twist: isolated fallopian tube torsion in an adolescent. Case Rep Surg 2013;2013:509424. doi: 10.1155/2013/509424.
32. Lai YL, Chen YL, Chen CA, Cheng WF. Torsion of pedunculated subserous uterine leiomyoma: A rare complication of a common disease. Taiwan J Obstet Gynecol 2018;57(2):300-303. doi: 10.1016/j.tjog.2018.02.021.
33. Foissac R, Sautot-Vial N, Birtwisle L, et al. Torsion of a huge pedunculated uterine leiomyoma. Am J Surg 2011;201(6):e43-5. doi: 10.1016/j.amjsurg.2010.04.025.