Imaging

Ovarian Torsion

Preliminary Diagnosis: Ovarian Torsion

I. What imaging technique is first-line for this diagnosis?

  • Grayscale and color Doppler ultrasound of the pelvis

  • Transvaginal is more specific and sensitive than companion transabdominal imaging. Transvaginal technique is recommended in sexually active patients while transabdominal is recommended in nonsexually active patients.

II. Describe the advantages and disadvantages of this technique for diagnosis of Ovarian Torsion.

Advantages

  • Highly portable

  • Relatively inexpensive and does not expose patients to ionizing radiation

  • Highly sensitive and specific in detecting and ruling out ovarian torsion

Disadvantages

  • Operator dependent

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to ultrasonography exist

IV. What alternative imaging techniques are available?

  • CT with contrast of the pelvis

  • MRI with contrast of the pelvis

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of Ovarian Torsion.

CT with contrast of the pelvis

Advantages

  • Offers better evaluation of the surrounding structures for any complications (ie, uterus, fallopian tubes, hemorrhagic ascites) than ultrasound

  • May help guide treatment

Disadvantages

  • Less sensitive and specific in diagnosing ovarian torsion than ultrasound

  • Exposure to ionizing radiation

MRI with contrast of the pelvis

Advantages

  • Offers better evaluation of the surrounding structures for any complications (ie, uterus, fallopian tubes, hemorrhagic ascites) than ultrasound

  • May help guide treatment

  • Does not use ionizing radiation

Disadvantages

  • Less sensitive and specific in diagnosing ovarian torsion than ultrasound

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

VI. What are the contraindications for the alternative imaging techniques?

CT with contrast of the pelvis

  • May be contraindicated in pregnant patients

MRI with contrast of the pelvis

  • Contraindicated in patients with non–MR-compatible hardware

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