Scoring System for Predicting Ovarian Necrosis in Adnexal Torsion Using an Ultra-Short, Optimized MRI Protocol

Abstract

Background:

Adnexal torsion constitutes an acute gynecological condition, and diagnostic imaging modalities are instrumental in its timely and accurate identification. Magnetic Resonance Imaging (MRI) is distinguished by its enhanced soft tissue discrimination capabilities, yielding comprehensive data pertaining to the adnexal structures, thereby facilitating the precise identification of torsion and its concomitant complications.

Methods:

This hospital-based, cross-sectional study employed 50 participants comprising females aged between 10 and 50 years, with ovarian or adnexal torsion established via Magnetic Resonance Imaging (MRI). The study's data collection was performed from February 2024 to February 2025, after obtaining Ethical Committee approval.

Results:

The mean duration for a conventional magnetic resonance imaging (MRI) examination was 36.1 minutes, whereas the optimized MRI protocol significantly reduced this to 6.2 minutes (p<0.05). The average participant age was determined to be 39.5 years. The etiology of torsion was known in 74% of cases, with 83.8% attributed to benign conditions and 16.2% to malignant pathologies. Within the benign category, functional cysts represented the primary etiological factor (29%), whereas endometrial adenocarcinoma constituted the foremost malignant contributor (50%). MRI findings with hypointensities in the pedicle, cyst wall, perifollicular regions, and stroma exhibited a significant association with hemorrhagic necrosis. The ultra-short MRI protocol predicted 93.1% of necrotic cases with a score of 2 or higher on the established MRI scoring system. This methodology exhibited superior diagnostic performance, characterized by a sensitivity of 93.1%, a specificity of 90.5%, and a positive predictive value of 93.1%.

Conclusion:

The ultra-short, optimized MRI protocol proves to be an exceptionally valuable diagnostic modality for the prediction of hemorrhagic necrosis in adnexal torsion.