Accuracy of imaging modalities for adnexal torsion: A systematic review and meta‐analysis

Baihas Wattar, Michael Rimmer, Ewelina Rogozinska, Mark Macmillan, Khalid S. Khan, Bassel H. Al Wattar

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Adnexal torsion (AT), a serious gynaecological emergency, often presents with non‐specific symptoms leading to delayed diagnosis.

Objective
To compare the test accuracy of ultrasound (USS), computerized tomography (CT), and magnetic resonance (MRI) to diagnose AT.

Search Strategy
We searched EMBASE, MEDLINE, and Cochrane CENTRAL until December 2019.

Selection criteria
Studies reporting on the accuracy of any imaging modality (Index Test) in females (paediatric and adults) suspected of AT compared to surgical diagnosis and/or standard clinical/radiological follow‐up period until resolution of symptoms (Reference Standard).

Data collection and Analysis
We assessed study quality using QUADAS‐2. We conducted test accuracy meta‐analysis using a univariate model or a hierarchical model.

Main Results
We screened 3836 citations, included 18 studies (1654 women, 665 cases), and 15 in the meta‐analyses. USS pooled sensitivity (n=12, 1187 women) was 0.79 (95%CI 0.63–0.92) and specificity was 0.76 (95%CI 0.54–0.93), with a negative and positive likelihood ratio of 0.29 (95%CI 0.13‐0.66) and 4.35 (95%CI 2.03‐9.32) respectively. Using Doppler with USS (n=7, 845 women) yielded similar sensitivity (0.80, 95%CI 0.67‐0.93) and specificity (0.88, 95%CI 0.72‐1.00). For MRI (n=3, 99 women), the pooled sensitivity was 0.81 (95%CI 0.63‐0.91) and specificity was 0.91 (95%CI 0.80‐0.96). A meta‐analysis for CT was not possible with two case‐control and one cohort studies (n=3, 232 women). Its sensitivity range was 0.74‐0.95, and specificity was 0.80‐0.90.

Conclusions
Ultrasound has good performance as a first‐line diagnostic test for suspected AT. Magnetic resonance could offer improved specificity to investigate complex ovarian morphology, but more evidence is needed.
Original languageEnglish
Article numberhttps://doi.org/10.1111/1471-0528.16371
JournalBritish journal of obstetrics and gynaecology
Early online date22 Jun 2020
DOIs
Publication statusE-pub ahead of print - 22 Jun 2020

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