Diagnosis of Ovarian Torsion: Is It Time to Forget About Doppler?

OBJECTIVE: Accuracy of ultrasound in diagnosis of ovarian torsion remains controversial, with some studies reporting correct diagnosis in only 23% to 66% of cases. Normal Doppler flow does not necessarily exclude an ovarian torsion; in fact, it may lead to missing the diagnosis and has been show to delay management. The objective of our study was to assess sensitivity and specificity of ultrasound diagnosis of ovarian torsion and to analyze the factors contributing to correct and incorrect diagnosis.

METHODS: All women presenting with abdominal pain and admitted for urgent/emergent surgery to the gynaecology service at a major teaching hospital between September 2010 and August 2015 were reviewed. Of those, 55 cases of surgically proven ovarian torsion and 48 control cases were selected. Ultrasound reports were reviewed and analyzed.

RESULTS: Sixty-one percent of right ovarian torsion case and 27% of left ovarian torsion cases had normal Doppler flow. Presence of ovarian cysts was significantly associated with torsion. Sensitivity of ultrasound was 70% and specificity was 87%.

CONCLUSION: While ultrasound can be used to support a diagnosis of ovarian torsion, it is a clinical diagnosis that requires integration of many factors, especially patient presentation and exclusion of other non-gynaecological pathologies. Doppler flow is not a useful variable to diagnose or exclude ovarian torsion and we recommend it should not be used to exclude a diagnosis of ovarian torsion.