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

Öz

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.

Anahtar Kelimeler

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

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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