Predicting necrosis in adnexal torsion in women of reproductive age using magnetic resonance imaging

• Published in: European radiology Vol. 30; no. 2; pp. 1054 - 1061
• Main Authors: Duan, Na, Rao, Min, Chen, Xiao, Yin, Yanyun, Wang, Zhongqiu, Chen, Rong
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2020; Springer Nature B.V
• Subjects: Age; Confidence intervals; Diagnosis; Diagnostic Radiology; Diagnostic systems; Hemorrhage; Imaging; Infarction; Internal Medicine; Interventional Radiology; Magnetic Resonance; Magnetic resonance imaging; Medical imaging; Medicine; Medicine & Public Health; Multivariate analysis; Necrosis; Neuroradiology; Patients; Prediction models; Radiology; Regression analysis; Resonance; Statistical analysis; Surgery; Surgical outcomes; Thickening; Ultrasound; Uterus; Ovary; Magnetic resonance imaging; Pelvic pain; Necrosis
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-06434-y

Purpose
To identify the diagnostic performance of magnetic resonance (MR) imaging for patients with adnexal torsion and to develop a predictive model for necrosis related to torsion.
Methods
The institutional ethics committee approved this retrospective study. A total of 56 women with a preoperative pelvic MR scan and a surgical and pathologic diagnosis of adnexal torsion were enrolled from five institutions. Three radiologists reviewed the MR images independently. The kappa value of interrater agreement was assessed. Differences between patients treated with conservative surgery and adnexectomy were evaluated by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the model to predict ovarian necrosis.
Results
Fifty-six patients were divided into the conservative surgery group (24/56, 42.9%) or the adnexectomy group (32/56, 57.1%) depending on the surgical outcomes. The radiographic features related to torsion were interpreted by three raters retrospectively with substantial interrater agreement (kappa > 0.60). Older reproductive age and pedicle hemorrhagic infarction were significantly associated with adnexectomy (
p
 < 0.05). At multivariate analysis, pedicle hemorrhagic infarction (odds ratio = 10.476 [95% confidence interval 1.103, 99.504;
p
 = 0.041]) was associated with adnexectomy. Using the predictive model (older reproductive age and pedicle hemorrhagic infarction), a receiver operating characteristic curve was generated with an area under the curve (AUC = 0.870 ± 0.049).
Conclusion
The presence of pedicle hemorrhagic infarction and older reproductive age can predict necrosis of adnexal torsion and may be used to guide the optimal treatment strategy.
Key Points
• Pedicle hemorrhagic infarction and older reproductive age are predictors of necrosis in adnexal torsion in patients of reproductive age (AUC = 0.870 ± 0.049).
• Cystic wall thickening, enlarged vascular pedicle, tubal thickening, and uterine deviation are associated with a high risk for adnexal torsion, occurring in more than half of the cases in this study.
• MR findings are useful for the definitive diagnosis of adnexal torsion and for the prediction of adnexal necrosis.