Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Rome, Italy.
Department of Fetal Medicine and Obstetric and Gynecologic Ultrasound, Manipal Hospital, Bangalore, India.
Ultrasound Obstet Gynecol. 2020 Dec;56(6):934-943. doi: 10.1002/uog.21981. Epub 2020 Nov 10.
To describe the clinical and ultrasound characteristics of adnexal torsion.
This was a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion, defined as surgical evidence of ovarian pedicle, paraovarian cyst and/or Fallopian tube twisted on its own axis, who had undergone preoperative ultrasound examination by an experienced examiner, between 2008 and 2018. Only cases with at least two available ultrasound images and/or videoclips (one grayscale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrieved from each patient's medical record and entered into an Excel file by the principal investigator at each center. In addition, two authors reviewed all available ultrasound images and videoclips of the twisted adnexa, with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: (1) ovarian stromal edema with or without peripherally displaced antral follicles, (2) the follicular ring sign, (3) the whirlpool sign and (4) absence of vascularization in the twisted organ.
A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range, 1-88) years. Most patients were premenopausal (284/314; 90.4%) and presented with acute or subacute pelvic pain (305/315; 96.8%). The surgical approach was laparoscopic in 239/312 (76.6%) patients and conservative surgery (untwisting with or without excision of a lesion) was performed in 149/315 (47.3%) cases. According to the original ultrasound reports, the median largest diameter of the twisted organ was 83 (range, 30-349) mm. Free fluid in the pouch of Douglas was detected in 196/275 (71.3%) patients. Ovarian stromal edema with or without peripherally displaced antral follicles was reported in the original ultrasound report in 167/241 (69.3%) patients, the whirlpool sign in 178/226 (78.8%) patients, absent color Doppler signals in the twisted organ in 119/269 (44.2%) patients and the follicular ring sign in 51/134 (38.1%) patients. On retrospective review of images and videoclips, ovarian stromal edema with or without peripherally displaced antral follicles (201/254; 79.1%) and the whirlpool sign (139/153; 90.8%) were the most commonly detected features of adnexal torsion.
Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged adnexa, the whirlpool sign, ovarian stromal edema with or without peripherally displaced antral follicles and free fluid in the pelvis. The follicular ring sign and absence of Doppler signals in the twisted organ are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that the correct treatment, i.e. surgery without delay, can be offered. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
描述附件扭转的临床和超声特征。
这是一项回顾性研究。从 8 个参与的妇科超声中心的手术记录中，我们确定了经手术证实为附件扭转的患者，附件扭转定义为卵巢蒂、卵巢旁囊肿和/或输卵管自身轴扭转的手术证据，这些患者在 2008 年至 2018 年间由有经验的检查者进行了术前超声检查。只有至少有两个可用的超声图像和/或视频（一个灰度和一个多普勒评估）的病例才包括在内。从每位患者的病历中检索临床、超声、手术和组织学信息，并由每个中心的主要研究者输入到 Excel 文件中。此外，两位作者回顾了所有扭曲附件的可用超声图像和视频，以评估四个预先定义的超声特征：（1）卵巢基质水肿伴或不伴周围移位的窦卵泡，（2）卵泡环征，（3）漩涡征，（4）扭曲器官内无血流。
共确定了 315 例附件扭转。患者的中位年龄为 30 岁（范围，1-88 岁）。大多数患者为绝经前（284/314；90.4%），表现为急性或亚急性盆腔疼痛（305/315；96.8%）。239/312（76.6%）例患者采用腹腔镜手术，149/315（47.3%）例患者采用保守手术（扭转并切除病变）。根据原始超声报告，扭曲器官的最大直径中位数为 83 毫米（范围，30-349 毫米）。275/275（71.3%）例患者在 pouch of Douglas 中有游离液。167/241（69.3%）例患者在原始超声报告中报告了卵巢基质水肿伴或不伴周围移位的窦卵泡，226/226（78.8%）例患者报告了漩涡征，269/269（44.2%）例患者报告了扭曲器官内无彩色多普勒信号，134/134（38.1%）例患者报告了卵泡环征。对图像和视频进行回顾性分析，附件扭转最常见的超声特征是卵巢基质水肿伴或不伴周围移位的窦卵泡（201/254；79.1%）和漩涡征（139/153；90.8%）。
大多数经手术证实的附件扭转患者处于生育年龄，表现为急性或亚急性疼痛。常见的超声征象是附件增大、漩涡征、卵巢基质水肿伴或不伴周围移位的窦卵泡和盆腔游离液。卵泡环征和扭曲器官内无多普勒信号是稍不常见的征象。认识附件扭转的超声征象很重要，以便能够提供正确的治疗方法，即不延误手术。版权所有 2020 ISUOG。由 John Wiley & Sons Ltd 出版。
