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Pearls and Pitfalls in Diagnosis of Ovarian Torsion¹

¹ From the Department of Imaging Sciences, University of Rochester School of Medicine, 601 Elmwood Ave, Box 648, Rochester, NY 14642. Recipient of a Certificate of Merit award for an education exhibit at the 2006 RSNA Annual Meeting. Received May 30, 2007; revision requested December 13 and received January 10, 2008; accepted January 24. All authors have no financial relationships to disclose. Address correspondence to V.S.D. (e-mail: Vikram_Dogra{at}urmc.rochester.edu).

Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Ovarian torsion is usually associated with a cyst or tumor, which is typically benign; the most common is mature cystic teratoma. Ultrasonography (US) is the primary imaging modality for evaluation of ovarian torsion. US features of ovarian torsion include a unilateral enlarged ovary, uniform peripheral cystic structures, a coexistent mass within the affected ovary, free pelvic fluid, lack of arterial or venous flow, and a twisted vascular pedicle. The presence of flow at color Doppler imaging does not allow exclusion of torsion but instead suggests that the ovary may be viable, especially if flow is present centrally. Absence of flow in the twisted vascular pedicle may indicate that the ovary is not viable. The role of computed tomography (CT) has expanded, and it is increasingly used in evaluation of abdominal pain. Common CT features of ovarian torsion include an enlarged ovary, uterine deviation to the twisted side, smooth wall thickening of the twisted adnexal cystic mass, fallopian tube thickening, peripheral cystic structures, and ascites. Understanding the imaging appearance of ovarian torsion will lead to conservative, ovary-sparing treatment.

© RSNA, 2008