目标:在急诊医学的环境中,盆腔和下腹痛反复出现,卵巢扭转在多种病因中构成了巨大的诊断难题。鉴于急性护理环境中对CT的日益依赖,它总是假定首要为主要的成像模式。这项研究试图阐明手术证实的卵巢扭转患者遇到的CT影像学表现,并利用CT来区分坏死。
方法:回顾性分析(1月,2015-4月,2019)利用医院档案对诊断为卵巢扭转的患者进行了检查,手术后。纳入标准包括在诊断后一周内接受CT检查的患者。包括中线方向的大量CT发现,子宫偏离,卵巢内血肿/肿块,和其他多个系统记录。
结果:90例患者被诊断为卵巢扭转-53(59%)在诊断后一周内进行了CT检查,41例(77%)进行了IV对比CT,12例(23%)没有进行IV对比。平均年龄为43岁(范围19-77岁),每个卵巢的受累分布几乎相等。平均最大卵巢直径为11.7±6.3cm(4.2~34.8cm)。最常见的影像学特征包括椎弓根增厚(43/53,81%),中线卵巢(41/53,77%),输卵管增厚(31/49,63%),同侧子宫偏位(33/53,62%)。根据同期影像学报告,在25/53研究中诊断出扭转,敏感性为47%。
结论:卵巢尺寸增大(>3.0cm),增厚的血管蒂或输卵管,卵巢中线配置伴同侧子宫偏位,在手术证实的卵巢扭转病例中,漩涡征的存在是主要的CT成像特征,作为放射科医生的关键诊断助手.合并盆腔游离液和卵巢内血肿表示坏死性改变,指示缺血严重程度和疾病进展。
OBJECTIVE: In the milieu of emergency medicine, pelvic and lower abdominal pain present recurrently, with ovarian torsion posing a formidable diagnostic quandary amid multifarious etiologies. Given the burgeoning reliance on CT in acute care settings, it invariably assumes primacy as the principal imaging modality. This study endeavors to elucidate the CT imaging manifestations encountered by surgically confirmed ovarian torsion patients and utilizing CT to differentiate necrosis.
METHODS: A retrospective analysis (January, 2015- April, 2019) utilizing hospital archives was conducted on patients diagnosed with ovarian torsion, post-surgery. Inclusion criteria encompassed patients who underwent CT examinations within one week of diagnosis. A large array of CT findings encompassing midline orientation, uterine deviation, intraovarian hematoma/mass, and multiple others were systematically documented.
RESULTS: 90 patients were diagnosed with ovarian torsion- 53 (59%) had CT within one week of diagnosis, 41(77%) underwent a CT with IV contrast and 12 (23%) without IV contrast. Mean age was 43 years (range 19-77 years), with near equal distribution of involvement of each ovary. Mean maximum ovarian diameter was 11.7 ± 6.3 cm (4.2-34.8 cm). Most common imaging features include the presence of thickened pedicle (43/53, 81%), midline ovary (41/53, 77%), presence of thickened fallopian tube (31/49, 63%), and ipsilateral uterine deviation (33/53, 62%). Based on contemporaneous imaging report, torsion was diagnosed in 25/ 53 studies giving a sensitivity of 47%.
CONCLUSIONS: Enlarged ovarian dimensions (> 3.0 cm), thickened vascular pedicle or fallopian tube, midline ovarian disposition with ipsilateral uterine deviation, and the presence of a whirlpool sign emerged as predominant CT imaging features in surgically confirmed ovarian torsion cases, serving as pivotal diagnostic aides for radiologists. Concomitant pelvic free fluid and intraovarian hematoma signify necrotic changes, indicative of ischemic severity and disease progression.