Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion
Abstract Objectives To evaluate the value of contrast-enhanced CT in diagnosing ultrasonography-unspecified adnexal torsion (AT). Methods Surgically confirmed patients with painful pelvic masses (n = 165) were retrospectively collected from two institutes. Two senior radiologists independently revie...
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SpringerOpen
2025-01-01
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| Series: | Insights into Imaging |
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| Online Access: | https://doi.org/10.1186/s13244-024-01885-4 |
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| author | Weili Xie Zhongren Huang Hongmei Kuang Xiaoxing Li Rixin Zhang Wei Zeng Cheng Jin Junyuan Zhong Jidong Peng Weiling Cheng Fuqing Zhou |
| author_facet | Weili Xie Zhongren Huang Hongmei Kuang Xiaoxing Li Rixin Zhang Wei Zeng Cheng Jin Junyuan Zhong Jidong Peng Weiling Cheng Fuqing Zhou |
| author_sort | Weili Xie |
| collection | DOAJ |
| description | Abstract Objectives To evaluate the value of contrast-enhanced CT in diagnosing ultrasonography-unspecified adnexal torsion (AT). Methods Surgically confirmed patients with painful pelvic masses (n = 165) were retrospectively collected from two institutes. Two senior radiologists independently reviewed the CT images and determined the Hounsfield unit difference between non-contrast vs portal venous phases (ΔHUPV-NC) in both derivation and validation samples. The cutoff value, sensitivity, specificity, predictivity, and reproducibility of the ΔHUPV-NC and other visually assessed CT signs were analyzed and compared using the receiver-operating characteristic curve, multivariable regression, and inter-rater agreement assays, respectively. Results Women with twisted (n = 73 [47 ± 19 years]) or untwisted (n = 92 [40 ± 15 years]) adnexal lesions were reviewed. The ΔHUPV-NC ≤ 17.5 HU (AUC: 0.91 [95% CI: 0.86, 0.96]; sensitivity: 95% [95% CI: 87, 98]; and specificity: 88% [95% CI: 80, 94]) was the independent predictor of AT (OR: 137 [95% CI: 39, 481], p < 0.001). After training in ΔHUPV-NC measurement, the agreement between two junior residents and the consensus increased from fair (resident-1: 0.29 [95% CI: 0.17, 0.41]; resident-2: 0.24 [95% CI: 0.1, 0.39]) to substantial (resident-1: 0.75 [95% CI: 0.65, 0.85]; resident-2: 0.72 [95% CI: 0.62, 0.83]). The post-training diagnostic accuracy (both residents: 81% [95% CI: 74, 87]) was higher than the pre-training accuracy (resident-1: 67% [95% CI: 59, 74], p = 0.007; resident-2: 66% [95% CI: 58, 73], p = 0.002). Conclusion The sign of ΔHUPV-NC ≤ 17.5 HU in contrast-enhanced CT can be used to predict the ultrasonography-unspecified AT. Critical relevance statement The decreased attenuation difference between non-contrast vs portal venous phases, a quantitative measurement-based CT sign, highlights the value of using contrast-enhanced CT as a second-line imaging approach after an equivocal ultrasonographic examination to diagnose AT in emergency settings. Key Points The value of contrast-enhanced CT in diagnosing ultrasonography-unspecified AT is underestimated. The ΔHUPV-NC ≤ 17.5 HU is the only predictor to diagnose the ultrasonography-unspecified AT. Contrast-enhanced CT can be used as a second-line imaging approach after an equivocal ultrasonographic examination. Graphical Abstract |
| format | Article |
| id | doaj-art-836f9c75fc5c4eb8826f07fd552f94bd |
| institution | Kabale University |
| issn | 1869-4101 |
| language | English |
| publishDate | 2025-01-01 |
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| series | Insights into Imaging |
| spelling | doaj-art-836f9c75fc5c4eb8826f07fd552f94bd2025-01-12T12:26:31ZengSpringerOpenInsights into Imaging1869-41012025-01-0116111310.1186/s13244-024-01885-4Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsionWeili Xie0Zhongren Huang1Hongmei Kuang2Xiaoxing Li3Rixin Zhang4Wei Zeng5Cheng Jin6Junyuan Zhong7Jidong Peng8Weiling Cheng9Fuqing Zhou10Department of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityMedical Imaging Center, Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University and Southern Medical UniversityMedical Imaging Center, Ganzhou People’s Hospital, The Affiliated Ganzhou Hospital of Nanchang University and Southern Medical UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityDepartment of Radiology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang UniversityAbstract Objectives To evaluate the value of contrast-enhanced CT in diagnosing ultrasonography-unspecified adnexal torsion (AT). Methods Surgically confirmed patients with painful pelvic masses (n = 165) were retrospectively collected from two institutes. Two senior radiologists independently reviewed the CT images and determined the Hounsfield unit difference between non-contrast vs portal venous phases (ΔHUPV-NC) in both derivation and validation samples. The cutoff value, sensitivity, specificity, predictivity, and reproducibility of the ΔHUPV-NC and other visually assessed CT signs were analyzed and compared using the receiver-operating characteristic curve, multivariable regression, and inter-rater agreement assays, respectively. Results Women with twisted (n = 73 [47 ± 19 years]) or untwisted (n = 92 [40 ± 15 years]) adnexal lesions were reviewed. The ΔHUPV-NC ≤ 17.5 HU (AUC: 0.91 [95% CI: 0.86, 0.96]; sensitivity: 95% [95% CI: 87, 98]; and specificity: 88% [95% CI: 80, 94]) was the independent predictor of AT (OR: 137 [95% CI: 39, 481], p < 0.001). After training in ΔHUPV-NC measurement, the agreement between two junior residents and the consensus increased from fair (resident-1: 0.29 [95% CI: 0.17, 0.41]; resident-2: 0.24 [95% CI: 0.1, 0.39]) to substantial (resident-1: 0.75 [95% CI: 0.65, 0.85]; resident-2: 0.72 [95% CI: 0.62, 0.83]). The post-training diagnostic accuracy (both residents: 81% [95% CI: 74, 87]) was higher than the pre-training accuracy (resident-1: 67% [95% CI: 59, 74], p = 0.007; resident-2: 66% [95% CI: 58, 73], p = 0.002). Conclusion The sign of ΔHUPV-NC ≤ 17.5 HU in contrast-enhanced CT can be used to predict the ultrasonography-unspecified AT. Critical relevance statement The decreased attenuation difference between non-contrast vs portal venous phases, a quantitative measurement-based CT sign, highlights the value of using contrast-enhanced CT as a second-line imaging approach after an equivocal ultrasonographic examination to diagnose AT in emergency settings. Key Points The value of contrast-enhanced CT in diagnosing ultrasonography-unspecified AT is underestimated. The ΔHUPV-NC ≤ 17.5 HU is the only predictor to diagnose the ultrasonography-unspecified AT. Contrast-enhanced CT can be used as a second-line imaging approach after an equivocal ultrasonographic examination. Graphical Abstracthttps://doi.org/10.1186/s13244-024-01885-4Ovarian torsionDiagnostic imagingCTAcute abdomenEmergency medicine |
| spellingShingle | Weili Xie Zhongren Huang Hongmei Kuang Xiaoxing Li Rixin Zhang Wei Zeng Cheng Jin Junyuan Zhong Jidong Peng Weiling Cheng Fuqing Zhou Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion Insights into Imaging Ovarian torsion Diagnostic imaging CT Acute abdomen Emergency medicine |
| title | Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion |
| title_full | Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion |
| title_fullStr | Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion |
| title_full_unstemmed | Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion |
| title_short | Decreased attenuation difference between non-contrast and portal-venous phases of CT predicts the ultrasonography-unspecified adnexal torsion |
| title_sort | decreased attenuation difference between non contrast and portal venous phases of ct predicts the ultrasonography unspecified adnexal torsion |
| topic | Ovarian torsion Diagnostic imaging CT Acute abdomen Emergency medicine |
| url | https://doi.org/10.1186/s13244-024-01885-4 |
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