Abstract
BackgroundTo assess the role of DWI in differentiation haemorrhagic ovary infarction from non-haemorrhagic one.MethodsFor this prospectively designed study, of 117 female patients who presented with acute lower quadrant pain and underwent MRI for suspicion of ovary torsion, results of only 29 patients (mean age, 24.7; SD, ±5.7; age range, 18–37), with surgical and pathological confirmation of adnexal torsion, were included to the study. All patients underwent DWI after conventional MRI. Quantitative and qualitative analysis of both the torsed and contralateral normal ovary were performed. Results of conventional MRI and DWI were noted.ResultsAt operation 15 patients were found to have haemorrhagic infarction while 14 had non-haemorrhagic infarction. Of the 29 patients, 17 torsed ovaries could be salvaged in a viable state. We found statistically significant correlation of the ADC values, between haemorrhagic and non-haemorrhagic ovary infarction. The ADC values were significantly lower in patients with haemorrhagic infarction than non-haemorrhagic ones (p < 0.001). Using an ADC threshold of 1.27, the sensitivity of DWI for haemorrhagic infarction was 0.93 and specificity 0.85.ConclusionDWI may be used with a significant success for the preoperative diagnosis of haemorrhagic infarction. This may be alerting for pre-emptive surgery in avoiding serious complications and preventing irreversible structural damage of the ovary.
Highlights
To assess the role of Diffusion-weighted imaging (DWI) in differentiation haemorrhagic ovary infarction from non-haemorrhagic one
Patient selection and inclusion criteria From a total of 117 female patients presenting with acute lower quadrant pain with suspicion of ovarian torsion who underwent magnetic resonance imaging (MRI) between August 2013 and December 2016, 29 patients with final surgical and pathological proof of adnexial torsion were included in this prospective study
Results of quantitative analysis of conventional MRI sequences (T1 and T2 images), DWI and Apparent diffusion coefficient (ADC) values by means of signal intensity ratios are summarised at Table 2
Summary
To assess the role of DWI in differentiation haemorrhagic ovary infarction from non-haemorrhagic one. Ovarian torsion results from a partial or complete rotation of an ovary or ovarian vascular pedicle about its long axis [1]. Complete torsion results in obstruction of the arterial blood supply, causing gangrenous, haemorrhagic infarction [2]. Ovarian torsion is a surgical emergency because a delay in diagnosis and surgery may lead to necrosis and loss of ovarian viability and to significant morbidity and even mortality. Despite significant progress in imaging technology, salvage surgery is still not possible in a great number of patients, due to delays in diagnosis [5,6,7]. Preoperative diagnosis of haemorrhagic infarction associated with serious complications and loss of ovarian viability may assist with decisions about pre-emptive surgery
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