The selected article for discussion during the month of September is:

“Sonographic Diagnosis of Ovarian Torsion: Accuracy and Predictive Factors,”  Mashiach, et al

Access the article here

Questions for Discussion:

1. The authors recommend that sonographic evaluation retain its place as the first-line imaging study for female patients with lower quadrant pain. Is this recommendation consistent with the protocol you follow?

2. What sonographic parameters have you found to be most reliable for ruling in or ruling out ovarian torsion?

3. What study design would you propose as a follow-up to this one, based on these observations by the authors?
   1. Of 8 torsion-related sonographic parameters evaluated in this study, abnormal ovarian blood flow and free fluid were the most accurate isolated sonographic signs of ovarian torsion.
   2. Combinations of sonographic signs had higher specificity values and PPVs for ovarian torsion
   3. Other “telltale findings” not evaluated as part of this study include twisted vascular pedicle and the whirlpool sign

4. Do you have questions for the authors?

Background and professional gap: Early diagnosis of ovarian torsion is important to prevent loss of the adnexa or ovary and, more rarely, potentially fatal thrombophlebitis or peritonitis.  Diagnosis poses a difficult challenge because the clinical presentation of ovarian torsion is variable and often misleading, and physical examination is often unhelpful

Study purpose:

To determine the accuracy of sonographic diagnosis of ovarian torsion and the predictive value of the various sonographic signs.

Study population:

Sixty-three women who underwent diagnostic laparoscopy after sonographic findings raised suspicion of ovarian torsion

Laparoscopic findings:

1-      In 47 cases, ovarian torsion was identified.

2-      Among the remainder, the most common finding was a hemorrhagic corpus luteum.

3-      4 women and had no abnormal findings.

Main sonographic findings:

1-      Sonographic diagnosis of ovarian torsion had overall accuracy of 74.6%.

2-      The most frequent laparoscopic finding in cases of an erroneous sonographic diagnosis of ovarian torsion was a hemorrhagic corpus luteum

3-      Abnormal ovarian blood flow and free fluid were the most accurate isolated sonographic signs of ovarian torsion

4-      A substantial proportion of women had ovarian torsion despite the presence of normal ovarian blood flow, lack of ovarian enlargement, and lack of an ovarian cyst or mass on sonography

5-      Combinations of sonographic signs had higher specificity values and PPVs for ovarian torsion

The authors note these study limitations:

1-      Fairly small sample size

2-      Retrospective design

3-      The use of data from various ultrasound operators

4-      Lack of data regarding false-negative diagnoses