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(searched for: MR Diagnosis of Ovarian Torsion)
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, Kenji Matsuzaki, Masafumi Harada
The British Journal of Radiology; doi:10.1259/bjr.20200110

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Aruna Singh
Archives of Clinical and Medical Case Reports, Volume 5, pp 54-55; doi:10.26502/acmcr.96550325

Na Duan, Min Rao, Xiao Chen, Yanyun Yin, , Rong Chen
European Radiology, Volume 30, pp 1054-1061; doi:10.1007/s00330-019-06434-y

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, Satoshi Goshima, , , Hiromi Koyasu, Masayuki Matsuo
Iranian Journal of Radiology, Volume 15; doi:10.5812/iranjradiol.14270

Abstract:
Background: Magnetic resonance (MR) imaging, have become more frequently used in the diagnosis of ovarian torsion, particularly in subacute cases. Objectives: To assess the characteristic findings and diagnostic performance of preoperative MR imaging for ovarian torsion. Methods: Twenty-three patients (age range, 10 - 58 years; mean age, 28.4 ± 12.5 years) with suspected ovarian torsion underwent preoperative MR imaging. Fifteen patients exhibited ovarian torsion, whereas the remaining eight did not. Two radiologists evaluated the MR imaging data in relation to six previously-described characteristics associated with ovarian torsion, and the sensitivity, specificity, and accuracy of this approach was determined. Results: Ovarian enlargement (maximum ovarian diameter > 4.0 cm; P = 0.032 for both readers) and a twisted pedicle (P = 0.0094 for reader 1, P = 0.0013 for reader 2) were significantly more common findings in patients with ovarian torsion compared with those without. The respective sensitivity, specificity, and accuracy of a twisted pedicle for the diagnosis of ovarian torsion were 73%, 88%, and 78%, respectively for reader 1 and 73%, 100%, and 83%, respectively for reader 2. Conclusions: Identifying a twisted pedicle in a patient is therefore, suggestive of ovarian torsion. Keywords: Magnetic Resonance Imaging; Ovary; Ovarian Torsion; Twisted Pedicle
Hakan Simsek
Vojnosanitetski pregled, Volume 75, pp 832-835; doi:10.2298/vsp160508364s

Abstract:
Introduction. Anterior sacral meningocele (ASM) is a very rare condition that is the herniation of the meningeal sac into the pelvic cavity through a developmental bone defect of the anterior wall of the sacrum. Most of the ASM are diagnosed in childhood but the reported cases that are diagnosed in adults exhibit a gamut of complications. Case report. We presented a case of ASM excision that was misdiagnosed as a giant ovarian cyst. A 28-year-old woman was admitted to the General Surgery Clinic and than to the Gynecology Department with suspect of ovarian cyst depending on ultrasonography (US) scans solely. Adnexial torsion was suspected and surgery to remove the cyst and adnexial exploration was planned. When the lesion was found out to be ASM, neurosurgery team tied the neck and excised the whole meningocele. Histopathologic evaluations confirmed dural sac. Neurological examinations right after the operation revealed 20% weakness in knee extension. It totally recovered in 6 months time. Her MR imaging studies and computed tomography (CT) scans revealed multiple ASM sacs and defects of the anterior wall of the sacrum. Conclusion. This case emphasizes the importance of utilizing available screening tools including CT andmagnetic resonance imaging (MRI) studies as the gold standard in addition to US scans in the preoperative period in order to accurately evaluate and characterize any pelvic lesion.
, Anne-Laure Rivain, Caroline Trichot, Marie-Chantal Morcelet, Sophie Prevot, Xavier Deffieux, Jocelyne De Laveaucoupet
Emergency Radiology, Volume 25, pp 51-59; doi:10.1007/s10140-017-1549-8

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, Jesse Wei, Koenraad J. Mortele, Kathryn Humm, Kim Thornton,
Fertility Research and Practice, Volume 3; doi:10.1186/s40738-017-0040-2

Abstract:
To determine if asymmetric ovarian edema on non-contrast MRI can be used to distinguish torsed from non-torsed stimulated ovaries in pregnant women. In this retrospective study, our radiology database was searched for women who were pregnant and who had undergone ovarian stimulation and underwent MRI abdomen/pelvis from 1/2000–12/2012. At our institution, ultrasound is typically performed as a first line study for pregnant women with pelvic pain, with MR for those patients with indeterminate findings. 64 pregnant women (gestational age range 3–37 weeks) were included. MRI indication, prospective interpretation, operative diagnosis, and follow-up were recorded. Two blinded radiologists (with a third radiologist tie-breaker) independently measured and described the ovaries, including the likelihood of torsion. If one or both ovaries/adnexa had an underlying lesion such as a dermoid, cystadenoma, or abscess, the patient was excluded from size and signal intensity comparison (N = 14). For the remaining 50 women, comparison was made of the ovaries in women with normal ovaries (N = 27), stimulated ovaries without torsion (N = 11), non-stimulated ovaries with torsion (N = 3), and stimulated ovaries with torsion (N = 3). Patients with asymmetric ovarian edema without stimulation or torsion (N = 3) and with polycystic ovary syndrome (N = 3) were analyzed separately. Average normal ovarian length was 3.2 cm, compared to 4.5 cm for asymmetric edema and 5.6–8.8 cm for the other four groups. Average difference in greatest right and left ovarian diameter was 19% for normal ovaries compared to 24–37% for the other 5 groups. Asymmetric signal on T2-weighted imaging (T2WI) was seen in 12% (3/27) of normal ovaries compared to 9% (1/11) of stimulated patients without torsion, 33% (1/3) of patients with PCOS and 67% (2/3) of patients with torsion both without and with stimulation. The correct diagnosis of torsion was made prospectively in 5/6 cases but retrospectively in only 3/6 cases. In patients with stimulation, correct diagnosis of torsion was made in 2/3 cases prospectively (both with asymmetric T2 signal) and retrospectively in only 1/3 cases. In 13/64 patients, other acute gynecologic and non-gynecologic findings were diagnosed on MRI. Enlarged edematous ovary can be seen with ovarian stimulation, ovarian torsion, or both. Although asymmetric ovarian edema occurred more frequently in patients with torsion than without, in pregnant patients with stimulated ovaries referred for MRI (typically after non-diagnostic ultrasound), ovarian torsion could not be confidently diagnosed or excluded retrospectively with non-contrast MRI.
Yuko Iraha, , Rin Iraha, Kimei Azama, , Maho Tsubakimoto, ,
RadioGraphics, Volume 37, pp 1569-1586; doi:10.1148/rg.2017160170

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Margarita V. Revzin, Mahan Mathur, Haatal B. Dave, Matthew L. Macer,
RadioGraphics, Volume 36, pp 1579-1596; doi:10.1148/rg.2016150202

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Published: 1 September 2016
Clinical Imaging, Volume 40, pp 1029-1033; doi:10.1016/j.clinimag.2016.06.003

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SpringerPlus, Volume 5; doi:10.1186/s40064-016-3123-3

Abstract:
Massive ovarian edema (MOE) is a rare disease and few reports have described the magnetic resonance (MR) imaging manifestations in pregnancy. We report here a case of MOE in a patient at 12 weeks' gestation. Abdominal T2-weighted MR images showed asymmetric ovarian enlargement in a teardrop configuration, hyperintense peripherally displaced follicles, and twisting of the vascular pedicle between the enlarged ovary and uterus. The diagnosis of MOE due to ovarian torsion was confirmed by exploratory laparotomy. Preoperative imaging, especially the MR imaging could distinguish MOE from other conditions and demonstrate the relations of adjunct organ, and allowed for untwisting during laparotomy with successful preservation of the ovary. Ultrasonography is important in detecting, evaluating, and determining the malignant potential of adnexal masses in pregnancy, but its findings may be nonspecific and then MR may assist characterization. This case was tentatively diagnosed as typical MOE by preoperative imaging, but the shape and location of the hugely enlarged ovarian mass suggested torsion of the ovarian pedicle. In our case, the diagnosis was confirmed by exploratory laparotomy and the pedicle was successfully untwisted. MR imaging proved useful for decisions on expectant management of MOE in pregnancy, and the patient's affected ovary could be preserved.
Reham M. Khalil,
The Egyptian Journal of Radiology and Nuclear Medicine, Volume 47, pp 621-629; doi:10.1016/j.ejrnm.2016.02.004

Abstract:
This study aimed to determine the different sonographic and MRI findings in surgically proven cases of ovarian torsion. The study retrospectively enrolled 14 incidences of surgically confirmed ovarian torsion. All patients had underwent US and MRI examination preoperatively. Retrospective review of patients’ radiological images and reports was conducted looking for the presence of imaging features of ovarian torsion. The most common findings in US and MRI were edematous enlarged ovary with peripherally displaced follicles and pelvic collection. Other common MR features included abnormal poor ovarian enhancement. MRI also appeared to be useful in detection of tube thickening and twisted pedicle which had different patterns increasing the reliability of ovarian torsion diagnosis. It is critical to be familiar with ovarian torsion manifestations on the different imaging modalities in order to expeditiously arrive to its diagnosis. The most common findings in US and MRI were edematous enlarged ovary with peripherally displaced follicles and pelvic collection. Other common MR features included abnormal poor ovarian enhancement. Also it appeared to be useful in detection of tube thickening and twisted pedicle which had different patterns increasing the reliability of ovarian torsion diagnosis.
Published: 1 January 2016
European Journal of Radiology, Volume 85, pp 286-290; doi:10.1016/j.ejrad.2015.10.002

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, I. Millet, F. Curros-Doyon, C. Faget, M. Fontaine,
Diagnostic and Interventional Imaging, Volume 96, pp 985-995; doi:10.1016/j.diii.2015.07.003

Abstract:
Acute pelvic pain in women is a common reason for emergency department admission. There is a broad range of possible aetiological diagnoses, with gynaecological and gastrointestinal causes being the most frequently encountered. Gynaecological causes include upper genital tract infection and three types of surgical emergency, namely ectopic pregnancy, adnexal torsion, and haemorrhagic ovarian cyst rupture. The main gastrointestinal cause is acute appendicitis, which is the primary differential diagnosis for acute pelvic pain of gynaecological origin. The process of diagnosis will be guided by the clinical examination, laboratory study results, and ultrasonography findings, with suprapubic transvaginal pelvic ultrasonography as the first-line examination in this young population, and potentially cross-sectional imaging findings (computed tomography and MR imaging) if diagnosis remains uncertain.
Published: 1 February 2014
Videoscopy, Volume 24; doi:10.1089/vor.2013.0170

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O. Tariel, C. Huissoud, R.C. Rudigoz, G. Dubernard
Journal de Gynécologie Obstétrique et Biologie de la Reproduction, Volume 42, pp 842-855; doi:10.1016/j.jgyn.2013.09.038

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, Ajay K. Singh, Robert A. Novelline
Radiation Oncology pp 207-218; doi:10.1007/174_2011_473

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S.E. Barton, K.C. Kurek, M.R. Laufer
Journal of Pediatric and Adolescent Gynecology, Volume 23; doi:10.1016/j.jpag.2009.05.001

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M Y Kim, S E Rha, S N Oh, Y J Lee, E S Jung, J Y Byun
The British Journal of Radiology, Volume 81; doi:10.1259/bjr/21920101

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, Theodore J. Dubinsky, Orpheus Kolokythas
Radiology Case Reports, Volume 3; doi:10.2484/rcr.v3i2.155

Abstract:
We present the clinical presentation, sonography, CT, and MR imaging as well as correlative intra-operative and gross pathological findings of ovarian torsion in a 14-year-old girl. Our findings are discussed in the context of prior imaging studies performed for the evaluation of ovarian torsion. Ovarian torsion is not an uncommon cause of acute abdominal pain in children and teenage girls. Diagnosis of this entity can be difficult based on clinical presentation or on imaging appearance alone.
Grace M. Kalish, Maitray D. Patel, Martin L. D. Gunn, Theodore J. Dubinsky
Ultrasound Quarterly, Volume 23, pp 167-175; doi:10.1097/ruq.0b013e31815202df

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, Raman Danrad, , , , Robert A. Novelline
RadioGraphics, Volume 27, pp 1419-1431; doi:10.1148/rg.275065021

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Eun-Ah Park, , Min Woo Lee, Sun Ho Kim, Chang Kyu Seong, Seung Hyup Kim
European Radiology, Volume 17, pp 3247-3254; doi:10.1007/s00330-007-0719-6

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, Oksana H. Baltarowich, Anna S. Lev-Toaff
Published: 1 April 2007
Ultrasound Clinics, Volume 2, pp 311-325; doi:10.1016/j.cult.2007.10.001

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Hiroki Matsumoto, Tsuyoshi Ohta, Kenji Nakahara, Takanobu Kojimahara, Hirohisa Kurachi
Gynecologic and Obstetric Investigation, Volume 63, pp 163-165; doi:10.1159/000096901

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, , Tsuneo Saga, Aki Kido, Masako Kataoka, Shigeaki Umeoka, Shingo Fujii, Kaori Togashi
European Radiology, Volume 16, pp 2700-2711; doi:10.1007/s00330-006-0302-6

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Comment
M. Canis
Gynécologie Obstétrique & Fertilité, Volume 33, pp 839-839; doi:10.1016/j.gyobfe.2005.08.010

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, M. Bazot, E. Barranger, R. Detchev, E. David-Montefiore, S. Uzan, E. Daraï
Gynécologie Obstétrique & Fertilité, Volume 33, pp 293-298; doi:10.1016/j.gyobfe.2005.03.025

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Katherine R. Birchard, Michele A. Brown, W. Brian Hyslop, Zeynep Firat, Richard C. Semelka
American Journal of Roentgenology, Volume 184, pp 452-458; doi:10.2214/ajr.184.2.01840452

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Aytekin Oto, Randy D. Ernst, Rajeev Shah, Mert Koroglu, Gregory Chaljub, Alfredo F. Gei, Nikolaos Zacharias, George Saade
Radiology, Volume 234, pp 445-451; doi:10.1148/radiol.2341032002

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Shinya Fujii, Toshibumi Kinoshita, Takatoshi Tahara, Eiji Matsusue, Toshihide Ogawa
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica, Volume 64, pp 533-43

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, Takashi Murakami, Sou-Ichi Nakamura, Yumi Sato, Hitoshi Niikura, Kiyoshi Ito, Nobuo Yaegashi, Kunihiro Okamura
The Tohoku Journal of Experimental Medicine, Volume 202, pp 239-243; doi:10.1620/tjem.202.239

Abstract:
Isolated torsion of the fallopian tube in premenarcheal girls is very rare. However, correct diagnosis and treatment are needed in order to optimize salvage of fallopian tube. Here, we report a case of fallopian tube torsion in a premenarcheal girl. A 12-year-old premenarcheal girl was admitted with a rapid history of colicky lower abdominal pain. MR image demonstrated normal ovaries and a large spherical cystic tumor with hemorrhage-like contents. The differential diagnosis included torsion of a para-ovarian cyst or hydrosalpinx, hemorrhage within a non-communicating uterine horn or a pelvic hemorrhage of unknown origin. Laparoscopic inspection/operation was performed. The distal portion of the left fallopian tube was swollen with two twists evident in the middle portion. The distal portion of the left fallopian tube was laparoscopically removed with the aid of a YAG laser. The mechanisms underlying disorders of the left fallopian tube are not well understood. However, some intrinsic/extrinsic causative factors are discussed. Although torsion of the fallopian tube occurs rarely and exhibits variable clinical features, the diagnosis should be considered in all young girls presenting with sudden colicky abdominal pain. Laparoscopic inspection/surgery appears to be the most suitable management.
, Katsumi Hayakawa, Kazuhiro Iwasaku, Kosho Takasu
Journal of Computer Assisted Tomography, Volume 27, pp 564-570; doi:10.1097/00004728-200307000-00021

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Sung E. Rha, Jae Y. Byun, Seung E. Jung, Jung I. Jung, Byung G. Choi, Bum S. Kim, Hyun Kim, Jae M. Lee
RadioGraphics, Volume 22, pp 283-294; doi:10.1148/radiographics.22.2.g02mr02283

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S Kawakami
Nihon Igaku Hoshasen Gakkai zasshi. Nippon acta radiologica, Volume 61

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T. L. Haque, K. Togashi, H. Kobayashi, S. Fujii, J. Konishi
European Radiology, Volume 10, pp 1954-1957; doi:10.1007/s003300000461

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A. S. Fulcher, R. A. Szucs
Abdominal Imaging, Volume 23, pp 640-644; doi:10.1007/s002619900421

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K. Shimada, I. Yamada, M. Maeda, T. Yamamoto, M. Oohara, T. Shibata, H. Shibuya
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Volume 168, pp 628-630; doi:10.1055/s-2007-1015292

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Michael Lishner, D. Zemlickis, Gideon Koren
Cancer in Pregnancy pp 131-133; doi:10.1017/cbo9780511663512.013

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