Gu Xiaowen, Jiang Lu, Xu Chijie, Yin Jianbing, Zhang Jibin, Cui Lei
Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China.
Department of Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou City, Jiangsu Province, China.
Int J Gynaecol Obstet. 2025 Jul;170(1):188-199. doi: 10.1002/ijgo.16153. Epub 2025 Jan 21.
To develop and validate an individualized nomogram for predicting adnexal torsion in women with abdominal pain and an adnexal mass based on preoperative non-contrast computed tomography (CT) findings.
This retrospective study included 200 women with surgically resected ovarian lesions who underwent preoperative non-contrast CT for abdominal pain from January 2017 to September 2023 in seven hospitals. The 200 patients were randomly divided into a development group (140 cases) and a validation group (60 cases). The independent risk factors for adnexal torsion from non-contrast CT signs were screened using univariate and multivariate logistic regression analyses. The corresponding nomogram prediction model was drawn according to the regression coefficients. The areas under the receiver operating characteristic curves (AUC) and the calibration plots were used to estimate the discrimination and calibration of the prediction model, respectively.
The most common lesion causing adnexal torsion was ovarian cyst (30.1%), followed by mature cystic teratoma (25.7%), whereas malignant tumors and tubo-ovarian abscesses were more common in non-torsioned patients. Multivariable regression analysis showed that navel sign (odds ratio [OR] 14.78; P = 0.005), whirl sign (OR 38.05; P = 0.002), and peri-adnexal fat haziness (OR 0.20; P = 0.012) were independent significant parameters predicting adnexal torsion. The AUC of the development group and validation group were 0.903 and 0.861, respectively, and the calibration curve suggested good agreement between the predictive probability and the actual probability.
Navel sign, whirl sign, and peri-adnexal fat haziness, and an integrated nomogram derived from these non-contrast CT findings, can be useful for predicting adnexal torsion, especially when ultrasound and contrast-enhanced CT cannot be used.
基于术前非增强计算机断层扫描（CT）结果，开发并验证一种用于预测腹痛伴附件包块女性附件扭转的个体化列线图。
这项回顾性研究纳入了200例接受手术切除卵巢病变的女性，她们于2017年1月至2023年9月在七家医院因腹痛接受了术前非增强CT检查。将200例患者随机分为开发组（140例）和验证组（60例）。使用单因素和多因素逻辑回归分析从非增强CT征象中筛选出附件扭转的独立危险因素。根据回归系数绘制相应的列线图预测模型。分别使用受试者操作特征曲线（AUC）下面积和校准图来评估预测模型的辨别力和校准度。
导致附件扭转最常见的病变是卵巢囊肿（30.1%），其次是成熟囊性畸胎瘤（25.7%），而非扭转患者中恶性肿瘤和输卵管卵巢脓肿更为常见。多变量回归分析显示，脐征（比值比[OR]14.78；P = 0.005）、漩涡征（OR 38.05；P = 0.002）和附件周围脂肪模糊（OR 0.20；P = 0.012）是预测附件扭转的独立显著参数。开发组和验证组的AUC分别为0.903和0.861，校准曲线表明预测概率与实际概率之间具有良好的一致性。
脐征、漩涡征和附件周围脂肪模糊，以及从这些非增强CT结果得出的综合列线图，可用于预测附件扭转，特别是在无法使用超声和增强CT的情况下。
