Ovarian volume ratio is a reliable predictor of ovarian torsion in girls without an adnexal mass

J Pediatr Surg. 2021 Jan;56(1):180-182. doi: 10.1016/j.jpedsurg.2020.09.031. Epub 2020 Oct 6.

Abstract

Purpose: The aims of this study were to identify ultrasound-based predictors of ovarian torsion in girls without an adnexal mass and establish a set of normal values for ovarian volume ratio (OVR).

Methods: A retrospective review was performed of all premenarchal patients ≥3 years of age with a normal pelvic ultrasound between January 2016 and January 2019. A comparison group of premenarchal girls presenting between 2011 and 2019 with torsion in the absence of an adnexal mass was utilized.

Results: Five-hundred and four premenarchal girls underwent pelvic ultrasound evaluation with a normal examination. The mean OVR was 1.6 ± 0.7 (range 1.0-6.5). OVR did not vary with age (r = -0.06) as compared to ovarian width which increased steadily with age (r = 0.53, p < 0.001). OVR was increased in girls with torsion (7.6 vs 1.4, p < 0.0001), and by receiver operating characteristic (ROC) analysis a cutoff value of >2.5 demonstrated the best diagnostic accuracy of any predictive variable (sensitivity 100%, specificity 94%, AUC 0.991, p < 0.001).

Conclusions: OVR is an excellent predictor of ovarian torsion in premenarchal girls without an adnexal mass. Unlike ovarian width, OVR does not increase with age, and a cutoff OVR > 2.5 demonstrates high sensitivity and specificity for identifying ovarian torsion in this population.

Type of study: Study of diagnostic test.

Level of evidence: Level III.

Keywords: Doppler flow; Ovarian torsion; Ovarian volume; Ovarian volume ratio; Ovarian width; Premenarchal.

MeSH terms

  • Adnexal Diseases* / diagnostic imaging
  • Adnexal Diseases* / pathology
  • Adolescent
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Organ Size
  • Ovarian Torsion* / diagnostic imaging
  • Ovarian Torsion* / pathology
  • Ovary* / diagnostic imaging
  • Ovary* / pathology
  • Retrospective Studies
  • Ultrasonography