Ultrasound Signs for Diagnosing Ovarian Torsion: A Five-Year Retrospective Study

Abstract

Abstract

Background:

Ovarian torsion is a gynaecologic emergency characterized by rotation of the adnexa, leading to compromised ovarian perfusion. Early diagnosis is critical to prevent irreversible ovarian damage. Ultrasound, particularly with Doppler imaging, is the frontline diagnostic tool.

Objective:

To evaluate the diagnostic value of specific grayscale and Doppler ultrasound features in patients with surgically confirmed ovarian torsion over a five-year period.

Methods:

A retrospective analysis was conducted on patients diagnosed with ovarian torsion between January 2020 and December 2024 at a tertiary care centre. All cases were confirmed intraoperatively. Preoperative ultrasound findings were assessed for ovarian enlargement, peripheral follicular distribution, twisted vascular pedicle (“whirlpool sign”), free pelvic fluid, stromal edema, and Doppler flow characteristics. Sensitivity, specificity, PPV, and NPV were calculated for each feature.

Results:

A total of 52 patients were included. The most frequent finding was ovarian enlargement (96%), which showed the highest sensitivity (96%) but lower specificity (30%). Peripheral follicular distribution was seen in 78% of cases, with moderate diagnostic accuracy (sensitivity 78%, specificity 65%). The twisted pedicle sign, present in 73% of patients, demonstrated the highest specificity (90%) and PPV (95%), making it the most reliable feature for confirming torsion. Absent or reduced Doppler flow was noted in 61% of cases, with moderate sensitivity (61%) and high specificity (85%). Additional supportive signs included free pelvic fluid (60%) and stromal edema (56%).

The combination of two or more ultrasound signs significantly improved diagnostic accuracy, supporting the need for comprehensive multimodal sonographic assessment rather than reliance on a single sign.

Keywords:s

Ovarian torsion, ultrasound, Doppler, twisted pedicle sign, ovarian enlargement, adnexal mass, gynaecologic emergency.