Is color Doppler ultrasonography reliable in diagnosing adnexal torsion? A large cohort analysis

Abstract

Introduction

Color Doppler ultrasonography (CDU) is widely used to diagnose adnexal torsion (AT). However, its validity remains questionable due to its low sensitivity. Our study aimed to evaluate the accuracy of CDU for the preoperative diagnosis of AT.

Material and methods

The electronic medical records of patients who were taken to the operating room with the diagnosis of suspected AT were reviewed. Patients having surgically/pathologically-proven AT were compared with patients who were found to have a different pathology at the time of surgery. CDU validity was assessed using a 2 × 2 table and compared with a diagnostic model that consists of the Doppler findings, patient’s age, and previous surgical history.

Results

AT was diagnosed correctly in 74.6% of cases. Absent Doppler flow was seen in only 18.6% of cases. Although its specificity and positive predictive value were high, CDU had very low sensitivity and negative predictive value. The combined diagnostic model exceeded CDU alone in terms of diagnostic accuracy.

Conclusions

The use of CDU alone is not a reliable modality to exclude AT. Absent Doppler flow is a sign of ovarian necrosis. Clinical correlation between CDU findings and the patient’s symptoms makes the diagnosis of AT more timely and accurate.

Keywords:

• Adnexal torsion
• ovarian torsion
• color Doppler ultrasonography
• Doppler validity

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.