Nizar Khatib, Deutsch Michael, Filmer Shlomo, Weizman Boris, Beloosesky Ron, Weiner Zeev
Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Israel.
J Clin Ultrasound. 2009 Oct;37(8):436-9. doi: 10.1002/jcu.20621.
To evaluate the role of ovarian Doppler studies in diagnosing adnexal torsion.
We included in that study all patients who had an adnexal mass with clinical symptoms of intermittent lower abdominal pain and were hospitalized for at least 48 hours of observation. Our protocol included: measurements of the size of the adnexal mass, presence or absence of ovarian edema, presence or absence of adnexal vascularity, presence or absence of ovarian artery flow, presence or absence of ovarian venous flow, pattern of ovarian venous flow. The ovarian artery and vein were sampled just above and lateral to the adnexa. Sensitivity, specificity, and positive and negative predictive values in the diagnosis of adnexal torsion were calculated for each of the gray-scale and Doppler sonographic (US) findings.
One hundred and ninety-nine patients presented with adnexal mass and intermittent lower abdominal pain. Sensitivity and specificity of tissue edema, absence of intra-ovarian vascularity, absence of arterial flow, and absence or abnormal venous flow in the diagnosis of adnexal torsion were: 21% and 100%, 52% and 91%, 76% and 99%, and 100% and 97%, respectively. All patients with adnexal torsion had absent flow or abnormal flow pattern in the ovarian vein. In 13 patients, the only abnormality was absent or abnormal ovarian venous flow with normal gray-scale US appearance and normal arterial blood flow. Of these 13 patients, 8 (62%) had adnexal torsion or subtorsion.
Abnormal ovarian venous flow may be the only abnormal US sign observed during the early stage of adnexal torsion.
评估卵巢多普勒检查在诊断附件扭转中的作用。
本研究纳入了所有患有附件包块且有间歇性下腹痛临床症状并住院观察至少48小时的患者。我们的方案包括：测量附件包块大小、有无卵巢水肿、有无附件血管、有无卵巢动脉血流、有无卵巢静脉血流、卵巢静脉血流模式。在附件上方和外侧对卵巢动脉和静脉进行采样。针对每一项灰阶和多普勒超声（US）检查结果，计算其在附件扭转诊断中的敏感性、特异性以及阳性和阴性预测值。
199例患者表现为附件包块和间歇性下腹痛。组织水肿、卵巢内无血管、无动脉血流以及无或异常静脉血流在附件扭转诊断中的敏感性和特异性分别为：21%和100%、52%和91%、76%和99%、100%和97%。所有附件扭转患者的卵巢静脉均无血流或血流模式异常。在13例患者中，唯一的异常是卵巢静脉无血流或血流异常，灰阶超声表现正常且动脉血流正常。在这13例患者中，8例（62%）有附件扭转或亚扭转。
卵巢静脉血流异常可能是附件扭转早期观察到的唯一异常超声征象。
