What is the role of imaging studies in the evaluation of ovarian torsion?

Updated: Jun 27, 2017
  • Author: Erik D Schraga, MD; Chief Editor: Eugene C Lin, MD  more...
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Diagnostic ultrasonography should be the first examination performed; typically, the affected ovary is enlarged, with multiple immature or small follicles along its periphery.

Ultrasonography with color Doppler analysis is the method of choice for the evaluation of adnexal torsion because it can show morphologic and physiologic changes in the ovary and can help in determining whether blood flow is impaired. [23, 10, 24, 25, 26, 11] . Gray-scale and spectral findings are correlated with the age of the torsion (ie, acute torsion or chronic torsion) and the degree of the twist or torsion. Normal Doppler imaging must not, however, be used as a basis for excluding the diagnosis.

Rarely, computed tomography (CT) or magnetic resonance imaging (MRI) is needed to make a definitive diagnosis. CT or MRI can serve as a secondary modality when ultrasonographic findings are nondiagnostic. [27, 28, 29]

Culdocentesis is a nonspecific test that is unlikely to confirm or exclude torsion and therefore is not recommended in the diagnostic workup.

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