Gould Sharon W, Mody Tejal, Gould Mary D, Kecskemethy Heidi, Veale Simone, Hossain Jobayer, Choudhary Arabinda K
Department of Radiology, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, USA.
Department of Nursing, MUSC Shawn Jenkins Children's Hospital, 10 McClennan Banks Drive, Charleston, SC, 29425, USA.
Emerg Radiol. 2025 May 6. doi: 10.1007/s10140-025-02346-1.
Diagnosing adnexal torsion is challenging due to non-specific presentation and ultrasound findings. MRI may provide alternative assessment of adnexal torsion. We evaluated an MRI appendicitis protocol for torsion identification.
Retrospective chart and image review was performed for girls with appendicitis MRI exams from 2013 to 2019. Ovarian volumes, stromal T2 signal, and apparent diffusion coefficient (ADC) ratios were tabulated. Ovarian and paratubal cysts' size and location were recorded as well as presence or absence of torsion. Statistical analysis was performed.
Six hundred-fifty cases were included, eight with torsion. Higher ovarian volumes and volume ratios were found with torsion (p < 0.0001 and p < 0.0001, respectively). Ovarian volume ratio less than 4:1 had 99.7% negative predictive value (NPV). Ovarian volume less than 20 mL had 99.8% NPV. Five of six cases with 7 cm or larger adnexal cysts were torsed. T2 signal and ADC ratios overlapped between torsed and untorsed groups. No torsed adnexa appeared normal on MRI.
Torsed cases tended to have larger ovaries and higher volume ratios. Adnexal cysts greater than 7 cm diameter were likely to be torsed. No torsion cases had normal adnexae on MRI. Normal appearing adnexae on MRI are very unlikely to be torsed.
由于临床表现和超声检查结果不具特异性，附件扭转的诊断具有挑战性。磁共振成像（MRI）可能为附件扭转提供另一种评估方法。我们评估了一种用于识别扭转的MRI阑尾炎检查方案。
对2013年至2019年接受阑尾炎MRI检查的女孩进行回顾性病历和图像审查。记录卵巢体积、间质T2信号和表观扩散系数（ADC）比值。记录卵巢囊肿和输卵管旁囊肿的大小及位置，以及是否存在扭转。进行统计学分析。
共纳入650例病例，其中8例发生扭转。扭转组的卵巢体积和体积比更高（分别为p < 0.0001和p < 0.0001）。卵巢体积比小于4:1时，阴性预测值（NPV）为99.7%。卵巢体积小于20 mL时，NPV为99.8%。6例附件囊肿直径达7 cm或更大的病例中有5例发生扭转。扭转组和未扭转组的T2信号和ADC比值存在重叠。MRI上没有扭转的附件看起来正常。
扭转病例往往卵巢更大，体积比更高。直径大于7 cm的附件囊肿可能发生扭转。MRI上没有扭转病例的附件是正常的。MRI上看起来正常的附件极不可能发生扭转。
