• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

What is the Best Diagnostic Tool for Suspected Adnexal Torsion?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Wattar et al. (BJOG, 2020) compared the accuracy of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) for diagnosing adnexal torsion

METHODS:

  • Systematic review and meta-analysis
  • Data sources
    • EMBASE, MEDLINE, Cochrane through December 2019
  • Study inclusion criteria
    • Female patients (pediatric and adult) suspected of adnexal torsion
    • Accuracy of ‘index test’ (any imaging modality) vs ‘reference standard’ (surgical diagnosis and/or standard clinical/radiological follow-up)
  • Study design
    • 2×2 tables constructed for each imaging modality
    • Sensitivity, specificity and likelihood ratios for positive and negative test results were calculated using with 95% CIs
    • If ≥4 studies available: Random effect model used
    • If <4 studies available: Univariate model used

RESULTS:

  • 18 studies (15 included in meta-analysis) | 1654 women | 665 cases of adnexal torsion
  • Ultrasound (n = 12; 1187 women)
    • Pooled sensitivity: 0.79 (95% CI, 0.63 to 0.92)
    • Specificity: 0.76 (95% CI, 0.54 to 0.93)
    • Negative likelihood ratio: 0.29 (95% CI, 0.13 to 0.66)
    • Positive likelihood ratio: 4.35 (95% CI, 2.03 to 9.32)
  • Doppler with ultrasound (n = 7; 845 women)
    • Sensitivity: 0.80 (95% CI, 0.67 to 0.93)
    • Specificity: 0.88 (95% CI, 0.72 to 1.00)
  • MRI (n = 3; 99 women)
    • Sensitivity: 0.81 (95% CI, 0.63 to 0.91)
    • Specificity: 0.91 (95% CI, 0.80 to 0.96)
  • CT (n = 3; 232 women)
    • Meta-analysis for CT was not possible due to small study ‘n’  
    • Sensitivity range: 0.74 to 0.95
    • Specificity range: 0.80 to 0.90

CONCLUSION:

  • Ultrasound performs well as a first line diagnostic tool for suspected adnexal torsion
  • The authors suggest that MRI may offer improved specificity, which could be helpful in a setting where the diagnosis is unclear, but there is a high index of suspicion | However, more evidence is necessary
  • The authors state

Currently, care for affected women is heterogeneous, often tailored by the attending clinician and their speciality of interest (emergency medicine, general surgery, urology, gynaecology) increasing the chance of delayed diagnosis and treatment

Developing and evaluating standardised care pathways with rapid access to imaging services is needed to improve the long‐term outcomes of women with AT

Learn More – Primary Sources:

Accuracy of imaging modalities for adnexal torsion: a systematic review and meta‐analysis

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

Diagnosis and Management of Adnexal Torsion in Adolescents
Is Ovarian Torsion Associated with Ligament Length?
Evaluation of the Adnexal Mass
Could Existing Ultrasound Predictive Models be Used to Better Predict Ovarian Cancer? 

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site