Preoperative CT image-based assessment for estimating risk of ovarian torsion in women with ovarian lesions and pelvic p
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Preoperative CT image‑based assessment for estimating risk of ovarian torsion in women with ovarian lesions and pelvic pain Jeong Ah Hwang1,2 · Hyeong Cheol Shin2 · Seung Soo Kim2 · Nam Hun Heo3 · Seo‑Youn Choi4 · Ji Eun Lee4 · Sunyoung Lee5 Received: 30 May 2020 / Revised: 27 August 2020 / Accepted: 3 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To define and weight the preoperative CT findings for ovarian torsion and to develop an integrated nomogram for estimating the probability of ovarian torsion in women with ovarian lesion and pelvic pain. Methods This retrospective study included 218 women with surgically resected ovarian lesions who underwent preoperative contrast-enhanced CT for pelvic pain from January 2014 to February 2019. Significant imaging findings for torsion were extracted using regression analyses and a regression coefficient-based nomogram was constructed. The diagnostic performance with sensitivity, specificity, and accuracy of the significant imaging findings and the nomogram were assessed. Results A total of 255 ovarian lesions (123 lesions with torsion and 132 lesions without torsion) were evaluated. Multivariable regression analysis showed that whirl sign (odds ratio [OR] 11.000; p 3 mm) [14, 15], (e) tubal thickening; an amorphous or tubular mass-like structure (> 10 mm) between uterine cornua and ovary [14, 15], (f) whirl sign; helical configuration of vascular structure near the ovarian
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Abdominal Radiology
lesion [1, 14], (g) hemorrhagic component within adnexal lesion; ovarian or tubal lesion had an attenuation > 50 Hounsfield unit (HU) on unenhanced CT [1, 15], (h) hemoperitoneum; the attenuation of ascites exceeded 50 HU on unenhanced CT [15], (i) ascites, four grades as follows; none or trace, limited to the cul-de-sac and not extending over the pelvis, fluid around the liver, paracolic gutters, and pelvis, or additional fluid between bowel loops [15], and (j) pelvic fat haziness and peritoneal thickening [14, 16]. In addition, the reviewers assigned a confidence rating regarding the likelihood of ovarian torsion based on the CT findings as follows: 1 for definitely absent; 2 for probably absent; 3 for indeterminate; 4 for probably present; 5 for definitely present. Bilateral ovarian lesions were evaluated, respectively, because synchronous bilateral torsion is rare, but can occur.
Statistical analysis Comparisons across groups based on ovarian torsion were evaluated using the Mann–Whitney test for continuous variables and chi-square or Fisher’s exact tests for categorical
variables. To determine imaging predictors for ovarian torsion, univariate and multivariable logistic regression analyses were performed. And a nomogram predicting the probability of ovarian torsion was built using the remaining independent predictors after stepwise multivariable logistic regression analysis with backward elimination. We performed fivefold cross-validation to assess the validity of the model. A receiver ope
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