Usefulness of Doppler sonography in the diagnosis of ovarian torsion

Objective: To assess the predictive value of Doppler sonography in the diag nosis of ovarian torsion and to correlate Doppler results with surgical fin dings and various clinical characteristics. Design: Retrospective study of discharged inpatients. Setting: An academic community hospital. Patient(s): Twenty-one patients with surgically confirmed ovarian torsion o ver an 8-year period. Intervention(s): Data were collected on Doppler flow results, ultrasound an d surgical findings, patient characteristics, and associated morbidity. Main Outcome Measure(s): Accuracy of Doppler diagnosis as to presence of ov arian torsion. Result(s): Twenty-one patients had surgically confirmed ovarian torsion. Do ppler sonography was performed in 10 of the 21 patients. Doppler sonographi c findings were normal in 60% (6 of 10), and abnormal (decreased or absent) in 40% suggestive of torsion. In cases involving ovulation induction, Dopp ler sonography findings were normal in 25% (1 of 4). Furthermore, the time to diagnosis of ovarian torsion (mean = 5.3 hours) and the time to hospital discharge (mean = 2 days) were both decreased when compared with instances when normal flow was detected by Doppler sonography (59 hours and 2.7 days , respectively). Conclusion(s): Abnormal flow detected by Doppler sonography is highly predi ctive of adnexal torsion and is therefore useful in the diagnosis of ovaria n torsion. However, when normal flow is detected by Doppler sonography, it does not necessarily exclude an ovarian torsion; in fact, torsion is missed in 60% of cases, and time to diagnosis in these cases is delayed. In cases of ovulation induction, sensitivity is increased to 75%. (Fertil Steril(R) 2000;73:1047-50. (C) 2000 by American Society for Reproductive Medicine).