Diagnostic accuracy of ultrasound in suspected ovarian torsion

Objective. Ultrasound has been proven to be useful in detecting underlying ovarian pathology. However, its role in the prediction of ovarian torsion has been controversial. The aim of the study was to assess the validity of ultrasound in the prediction of ovarian torsion in patients with acute pelvic pain related to clinically suspected ovarian torsion. Methods. A retrospective observational study was conducted at the Obstetrics/Gyneacology department using a 10-year chart review of all female patients older than 11 years of age with highly suspected ovarian torsion who underwent clinical assessment and ultrasound prior to surgery (n=62). The sensitivity and specificity of ultrasound were determined by cross-tabulation of the ultrasound and surgical findings. Results. Of the suspected cases, 54 (87.1%) were confirmed to be cases of ovarian torsion by surgery. The majority of the cases were suggestive of ovarian torsion, which was indicated by clinical examination (77.4%), ultrasound (77.4%), or pathological examination (79%). Almost one-half of the cases (46.8%) showed a pain score >6; two-thirds (62.9%) presented with vomiting and/or nausea; and more than one-third (38.7%) presented with leukocytosis. The estimated sensitivity and specificity of ultrasound were 0.74 and 0.0, respectively. The positive predictive value was 0.83. Ultrasound was significantly associated with both clinical examination (P=0.039) and pain score (P=0.008). Conclusion. The diagnosis of ovarian torsion cannot be exclusively based on ultrasound. Both clinical and sonographical evaluation of acute pelvic pain should be considered for the diagnosis. A definitive diagnosis remains challenging.