Ovarian torsion-diagnostic features on imaging

Abstract

Purpose Ovarian torsion is a gynaecological emergency. The clinical features can, however, be obscured by multiple co-morbidities, especially in the older age group. The purpose of the article is to demonstrate the diagnostic features of ovarian torsion with a multimodality review of cases. The case review also attempts to distinguish torsion-detorsion as compared to complete irreversible torsion on the basis of clinical symptoms and ovarian morphology. Methods and materials Six cases of ovarian torsion have been reviewed and their imaging features analysed with respect to clinical presentation. Results Ovarian torsion can be diagnosed confidently on magnetic resonance imaging (MRI), however, torsion–detorsion needs to be kept in mind in patients with fluctuating symptoms and a predisposing pathology, for example, cyst/tumour if there is no associated peri-ovarian inflammation. Computed tomography (CT) diagnosis was possible in one of the three cases analysed for this study. CT diagnosis is dependent on the amount of intraperitoneal fat and scan quality. Ultrasound features are fairly typical in the younger age group but may be difficult to assess in the older age group or in the presence of an underlying tumour. Conclusion A high clinical suspicion and appropriate history helps in targeted imaging and early diagnosis. MRI is a very sensitive modality in our experience for a definitive diagnosis. Early correct diagnosis helps appropriate surgical planning.