Garde I, Paredes C, Ventura L, Pascual M A, Ajossa S, Guerriero S, Vara J, Linares M, Alcázar J L
Department of Obstetrics and Gynecology, Hospital Universitario de Cruces, Bilbao, Spain.
Department of Obstetrics and Gynecology, Hospital Materno-Infantil, Badajoz, Spain.
Ultrasound Obstet Gynecol. 2023 Mar;61(3):310-324. doi: 10.1002/uog.24976. Epub 2023 Feb 11.
To evaluate the diagnostic accuracy of different ultrasound signs for diagnosing adnexal torsion, using surgery as the reference standard.
This was a systematic review and meta-analysis of studies published between January 1990 and November 2021 evaluating ovarian edema, adnexal mass, ovarian Doppler flow findings, the whirlpool sign and pelvic fluid as ultrasound signs (index tests) for detecting adnexal torsion, using surgical findings as the reference standard. The search for studies was performed in PubMed/MEDLINE, CINAHL, Scopus, The Cochrane Library, ClinicalTrials.gov and Web of Science databases. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios were calculated separately, and the post-test probability of adnexal torsion following a positive or negative test was also determined.
The search identified 1267 citations after excluding duplicates. Eighteen studies were ultimately included in the qualitative and quantitative syntheses. Eight studies (809 patients) analyzed the presence of ovarian edema, eight studies (1044 patients) analyzed the presence of an adnexal mass, 14 studies (1742 patients) analyzed ovarian Doppler flow, six studies (545 patients) analyzed the whirlpool sign and seven studies (981 patients) analyzed the presence of pelvic fluid as ultrasound signs of adnexal torsion. Overall, the quality of most studies was considered to be moderate or good. However, there was a high risk of bias in the patient-selection and index-text domains (with the exception of the whirlpool sign) in a significant proportion of studies. Pooled sensitivity, specificity, and positive and negative likelihood ratios of each ultrasound sign were 58%, 86%, 4.0 and 0.49 for ovarian edema, 69%, 46%, 1.3 and 0.67 for adnexal mass, 65%, 91%, 7.6 and 0.38 for the whirlpool sign, 53%, 95%, 11.0 and 0.49 for ovarian Doppler findings and 55%, 69%, 1.7 and 0.66 for pelvic fluid. Heterogeneity was high for all analyses.
The presence of an adnexal mass or pelvic fluid have poor diagnostic accuracy as ultrasound signs of adnexal torsion, while the presence of ovarian edema, the whirlpool sign and decreased or absent ovarian Doppler flow have good specificity but moderate sensitivity for detecting adnexal torsion. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
以手术作为参考标准，评估不同超声征象诊断附件扭转的诊断准确性。
这是一项系统综述和荟萃分析，纳入1990年1月至2021年11月发表的研究，这些研究评估卵巢水肿、附件包块、卵巢多普勒血流表现、漩涡征和盆腔积液作为超声征象（指标检测）用于检测附件扭转，以手术结果作为参考标准。在PubMed/MEDLINE、CINAHL、Scopus、Cochrane图书馆、ClinicalTrials.gov和Web of Science数据库中检索研究。使用诊断准确性研究质量评估-2（QUADAS-2）工具评估研究质量。分别计算合并敏感度、特异度、阳性和阴性似然比，并确定检测结果为阳性或阴性后附件扭转的验后概率。
排除重复文献后检索到1267条引文。最终18项研究纳入定性和定量综合分析。8项研究（809例患者）分析了卵巢水肿的存在情况，8项研究（1044例患者）分析了附件包块的存在情况，14项研究（1742例患者）分析了卵巢多普勒血流，6项研究（545例患者）分析了漩涡征，7项研究（981例患者）分析了盆腔积液作为附件扭转的超声征象。总体而言，大多数研究的质量被认为是中等或良好。然而，在相当比例的研究中，患者选择和指标检测领域（漩涡征除外）存在较高的偏倚风险。各超声征象的合并敏感度、特异度、阳性和阴性似然比分别为：卵巢水肿58%、86%、4.0和0.49；附件包块69%、46%、1.3和0.67；漩涡征65%、91%、7.6和0.38；卵巢多普勒表现53%、95%、11.0和0.49；盆腔积液55%、69%、1.7和0.66。所有分析的异质性都很高。
附件包块或盆腔积液作为附件扭转的超声征象诊断准确性较差，而卵巢水肿、漩涡征以及卵巢多普勒血流减少或消失对检测附件扭转具有良好的特异度，但敏感度中等。© 2022作者。《超声妇产科》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
