Torsion of a normal adnexa in a premenarcheal girl: MRI findings

Usefulness of T2*-weighted MRI in the detection of adnexal torsion

Background

The usefulness of T2*-weighted (T2*W) imaging for the detection of adnexal torsion has yet to be determined.

Purpose

To assess the usefulness of T2*W imaging for detecting and differentiating adnexal torsion.

Material and Methods

Eight patients with eight ovaries with torsion and 44 patients with 72 ovaries without torsion were included in this study. All patients underwent 1.5-T magnetic resonance imaging (MRI) including T2*W images. The frequency and distribution of hypointensity on T2*W images were compared between ovaries with torsion and ovaries without torsion.

Results

Hypointensity on T2*W images was significantly more frequent in ovaries with torsion than in ovaries without torsion (75% vs. 36%; P < 0.05). Among patients with hypointensity on T2*W images, the frequency of diffuse hypointensity was significantly higher in ovaries with torsion than in ovaries without torsion (83% vs. 0%; P < 0.01); whereas the frequency of focal hypointensity was significantly lower in ovaries with torsion than in ovaries without torsion (17% vs. 100%; P < 0.01).

Conclusion

The presence and distribution of hypointensity on T2*W images may play a supplementary role in the detection of adnexal torsion.

Fallopian tube torsion in the pediatric age group: radiologic evaluation

Fallopian tube torsion is a rare but important cause of acute pelvic pain in young adolescent girls. It is a surgical emergency treated with either detorsion or salpingectomy. The imaging findings can be nonspecific and challenging. However, an accurate early diagnosis is essential for prompt surgical treatment. Our objective was to review whether imaging findings can be specific enough to suggest the diagnosis of tubal torsion prospectively in the appropriate clinical setting. An Institutional Review Board-approved retrospective review of our imaging database from 2005 to 2012 revealed 10 surgically proven cases of fallopian tube torsion. All cases had sonography performed; 5 cases had additional multidetector computed tomography. All 10 patients (9-17 years) presented with acute pelvic pain. Sonographic findings included dilated tubular structures in 6 of 10 cases: adjacent to a normal ipsilateral ovary in 5 of 6 and adjacent to a benign ovarian teratoma in 1. In 4 cases, no dilated tube was identified; 3 of 4 had a cystic mass separate from the ovaries, and 1 had the imaging appearance of a multicystic ovary. Computed tomographic findings in the 5 cases that underwent multidetector computed tomography included a dilated tubular structure in 3 of 5; 2 of 5 had a cystic adnexal mass identified. Although rare, tubal torsion should be considered in female adolescents with acute pelvic pain. Sonography should be the first imaging choice. When a tubular structure or a midline cystic mass associated with a normal ipsilateral ovary is noted, tubal torsion should be considered in the differential diagnosis.

Diffusion-weighted imaging of ovarian torsion: usefulness of apparent diffusion coefficient (ADC) values for the detection of hemorrhagic infarction

PURPOSE

We undertook this study to evaluate the need for diffusion-weighted (DW) magnetic resonance (MR) imaging in detecting hemorrhagic infarction following ovarian torsion.

METHODS

The study included 14 consecutive patients aged 12 to 74 years (average age, 36 years) with surgical confirmation of ovarian torsion who underwent 1.5-tesla MR imaging. Pathologically, hemorrhagic infarction was found in 7 patients. We retrospectively reviewed signal intensity on T1-, T2-, and diffusion-weighted images and apparent diffusion coefficients (ADCs) in swollen ovarian stroma.

RESULTS

Fallopian tube thickening was seen in all patients. In patients with ovarian cystic lesion, maximum cyst wall thickness was significantly higher in patients with hemorrhagic infarction (mean, 13.5 ± 4.1 mm) than those without (mean, 5.0 ± 1.0 mm) (P < .05). Signal intensity did not differ significantly on T1-weighted, T2-weighted, and DW images between patients with and without hemorrhagic infarction. ADCs were significantly lower in patients with hemorrhagic infarction (1.20 ± 0.50 [× 10(-3) mm(2)/s]) than those without (2.04 ± 0.26 [× 10(-3) mm(2)/s]) (P < .01). With an ADC threshold of 1.80 [× 10(-3) mm(2)/s], sensitivity for hemorrhagic infarction was 0.88 (7 of 8), and specificity was 1.00 (6 of 6).

CONCLUSION

ADC measurements were useful for detecting hemorrhagic infarction in patients with ovarian torsion.

Noninflammatory fallopian tube pathology in children

Noninflammatory tubal abnormalities are rare in children and usually not well covered by traditional educational material. The presenting symptoms are nonspecific and are common to many other conditions, so its preoperative diagnosis is rarely made. The purpose of this study was to review the hospital charts and imaging findings in children and sexually inactive adolescents who showed fallopian tube pathology. Understanding of the pertinent findings of previous imaging examinations might assist radiologists in making the correct preoperative diagnosis and increase the likelihood of preserving the fallopian tubes. The clinical entities described in this article include isolated tubal torsion, paratubal cysts, hydrosalpinx, undescended/ectopic fallopian tube, and tubal inguinal hernia.

Massive ovarian edema with torsion: unusual hemorrhage and the recovery of contrast enhancement

We report a case of massive ovarian edema due to left adnexal torsion. On initial magnetic resonance (MR), unusual hemorrhages were demonstrated as several hypointense areas on T2-weighted images. The lack of contrast enhancement was also observed in the left adnexa. Abdominal pain resolved spontaneously, and then follow-up MR demonstrated the recovery of enhancement and hemorrhages as hyperintense signals on T1-weighted images.

Torsion of the normal ovary and oviduct in a pre-pubertal girl

We encountered a 10-year-old prepubertal girl with a normal ovary and oviduct torsion. Hemorrhagic infarction of the ovary and oviduct occurred, and these structures were laparoscopically removed. Torsion of the normal ovary and oviduct in a prepubertal girl is discussed.

Imaging of vascular disorders of the female pelvis

Clinical presentation of vascular disorders of female pelvis including placental adhesion, retained product of conception, ovarian venous thrombosis, varices, torsion and haemorrhagic infarct of ovary is often non-specific. Because of its availability, safety, and cost-effectiveness, ultrasound is the first investigation of choice. Computed tomography and MRI clearly depict the pelvic and retroperitoneal anatomy. This pictorial essay illustrates the complementary role of US, CT, and MRI in diagnosing vascular disorders of female pelvis.

Adnexal torsion following gonadotropin-releasing hormone analog therapy: a case report

Adnexal torsion may occur in girls and adolescents. Often it is associated with ovarian diseases resulting in ovarian enlargement. Adnexal torsion may involve the ovary, fallopian tube or both, and the main symptom is acute pelvic pain. An 8-year-old girl complaining of acute pelvic and abdominal pain, who was previously diagnosed with precocious puberty and who received treatment with a GnRH analog, is reported. Ultrasound demonstrated a normal-sized uterus and bilaterally enlarged ovaries with multiple internal cysts. At laparotomy, we found a complete torsion in the right adnexa. The histological examination revealed massive edema associated with multiple antral follicles and reduction of the follicular reserve.

[Emergency ultrasound diagnosis of ovarian torsion in children : nine case reports]

OBJECTIVE

To report the ultrasonographic aspects of ovarian torsion in nine pediatric cases.

PATIENTS AND METHODS

The age range was from 16 months to 14 years. The patients presented with a variety of symptoms, including pain in the site of torsion. Ultrasonography was performed in all patients, and color Doppler studies in four.

RESULTS

Ultrasonography showed a cystic mass in six patients, a solid mass with peripheral cysts in two patients and an adnexal cyst in one patient. Color Doppler revealed absence of flow in three patients. The patients were treated by coeliosurgery.

CONCLUSION

Ovarian torsion is a serious gynecologic emergency. Torsion is rare during childhood and has a non-specific clinical presentation. Ultrasound and Doppler are the imaging study of choice. The ovarian salvage was attributable to the combination of delay in patient presentation and surgical delay.

Adnexal torsion: Magnetic resonance findings in the viable adnexa with emphasis on stromal ovarian appearance

PURPOSE

To evaluate ultrasound (US) and magnetic resonance (MR) findings in the viable twisted adnexa.

MATERIALS AND METHODS

Ten patients underwent US and MR studies before surgical detorsion. Corrected cross-sectional area of the ovary was defined as cross-sectional area minus areas of cysts and follicles superior to 1 cm. On T2-weighted images, signal intensity of the stroma was graded as type 1 when it was equal to that of urine and type 2 when it was less than that of urine but markedly more than the contralateral side.

RESULTS

The tube was twisted in six cases and the ovary in nine cases. All adnexa were viable. The largest ovarian cross-sectional area and the largest corrected ovarian cross-sectional area of the twisted ovary were significantly larger than those of the contralateral ovary (P = 0.043 for US; P = 0.012 and 0.017, respectively, for MR). These ovaries contained types 1 and 2 hyperintensity in six cases and only type 2 hyperintensity in three cases. Tubal thickening was seen on MR in five cases.

CONCLUSION

Tubal thickening, enlargement of ovarian stroma as reflected by the corrected cross-sectional area, and hyperintensity of this stroma on T2-weighted images probably related to edema were useful findings in these viable torsions.

Severe spontaneous ovarian hyperstimulation syndrome with MR findings

We describe a case of severe spontaneous ovarian hyperstimulation syndrome (OHSS) with MR findings. MR scans showed bilateral symmetric enlargement of ovaries with multiple cystic changes, giving the classic "wheel-spoke" appearance. There was no definite abnormally thickened or enhanced wall, but there was internal hemorrhage in some chambers. To avoid unnecessary laparotomy, we emphasize the importance of careful diagnosis to differentiate spontaneous OHSS from ovarian cystic neoplasms.