Added value of MRI for the diagnosis of adnexal torsion in children and adolescents after inconclusive ultrasound examination - 16/05/20

Doi : 10.1016/j.diii.2020.04.015

E. Rougier ^a, W. Mar ^b, V. Della Valle ^a, B. Morel ^a, S. Irtan ^c, E. Audureau ^d, A. Coulomb-L’Hermine ^e, H. Ducou Le Pointe ^a, E. Blondiaux ^a,⁎
^a Department of Imaging, Hôpital Trousseau, Hôpitaux Universitaires de l’Est Parisien, Assistance publique–Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
^b Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612, USA
^c Department of Surgery, Hôpital Trousseau, Hôpitaux Universitaires de l’Est Parisien, Assistance publique–Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France
^d Biostatistic and Epidemiology Department, Hôpital Henri-Mondor, Assistance publique–Hôpitaux de Paris, LIC EA 4393, Université Paris-Est Créteil, 91000 Créteil, France
^e Department of Pathology, Hôpital Trousseau, Hôpitaux Universitaires de l’Est Parisien, Assistance publique–Hôpitaux de Paris, Sorbonne Université, 75012 Paris, France

^⁎Corresponding author. Sorbonne Université, Assistance ublique–Hôpitaux de Paris, Department of Radiology, Hôpital Armand-Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.Sorbonne Université, Assistance publique–Hôpitaux de Paris, Department of Radiology, Hôpital Armand-Trousseau26, avenue du Dr-Arnold-NetterParis75012France

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Highlights

•	The diagnosis of adnexal torsion in children is often difficult and initial ultrasound examination may be inconclusive.
•	Magnetic resonance imaging has good sensitivity and specificity for the diagnosis of adnexal torsion in children.
•	Magnetic resonance imaging should be used a problem solving tool for the diagnosis of adnexal torsion in children with inconclusive ultrasound examination.
•	Magnetic resonance imaging should not delay surgery in children with adnexal torsion.

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Abstract

Purpose

The purpose of this study was to assess the performance of magnetic resonance imaging (MRI) in children and adolescents with suspected adnexal torsion (AT) after inconclusive initial ultrasound examination.

Materials and methods

Twenty-eight girls with a mean age of 12±4 (SD) years (range: 1 month to 18years) were included. All had clinically suspected AT and inconclusive initial ultrasound findings followed by pelvic MRI as a second-line imaging modality. The final diagnosis was obtained by surgery or follow-up. Two radiologists blinded to the clinical, ultrasound and surgical data, retrospectively and independently reviewed MRI examinations. Clinical and MRI features associated with AT were searched for using univariate analyses.

Result

Among the 28 patients, 10/28 patients (36%) had AT and 22/28 (79%) had an ovarian or tubal mass. AT was associated with an age<13years (OR: 10.7; 95% CI: 1.3–148.2) (P=0.022) and a whirlpool sign at MRI (OR: 61.0; median unbiased estimate, 7.2) (P<0.0001). When a mass was present, the best quantitative MRI criteria for AT were mass volume and ovary-corrected volume≥30cm³ (κ=0.72 and 0.61, respectively), mass axis length≥5cm (κ=0.90), and mass surface area≥14 cm² (κ=0.58), with moderate to almost perfect interobserver agreement. The overall sensitivity, specificity and accuracy of MRI for the diagnosis of AT were 100% (10/10; 95% CI: 69–100), 94% (17/18; 95% CI: 73–100) and 96% (27/28; 95% CI: 82–100) respectively, with perfect interobserver agreement (κ=1).

Conclusion

In pediatric patients with suspected AT and inconclusive initial ultrasound examination, a strategy including MRI as a second-line imaging modality should be considered if MRI does not delay a potential surgery.

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Keywords : Adnexal torsion, Ovarian torsion, Child, Ultrasonography, Magnetic resonance imaging (MRI)