| Objective:(1)To explore the diagnostic value of ultrasound whirlpool sign(Whirlpool sign,WS)for female adnexal torsion.(2)To explore the value of color Doppler ultrasound combined with whirlpool sign to predict ovarian outcome of female adnexal torsion.Methods: The data of surgical results of hospitalized patients(2304 cases)with lower abdominal pain and adnexal masses from July 2006 to July 2018 in our hospital and the clinical and ultrasound data of 67 patients with adnexal torsion were collected and statistically analyzed.(1)There were 2304 female hospitalized patients with lower abdominal pain and adnexal masses.According to the results of ultrasound,the patients were divided into the WS positive group and WS negative group.According to the surgical results,the patients were divided into the torsion group and the non-torsion group.Calculate the sensitivity,specificity,accuracy,positive predictive value,negative predictive value and?value of WS to diagnose adnexal torsion.(2)There were 45 cases of adnexal torsion with WS positive.According to the preoperative color Doppler ultrasound results,they were divided into three groups: group A(the arteriovenous blood flow in the pedicle),group B(only arterial blood flow in the pedicle),Group C(blood flow loss in the pedicle).According to ovarian outcomes,they were divided into necrotic group and non-necrotic group.The correlation between pedicle blood flow and ovarian necrosis was calculated and the predictive accuracy of ovarian necrosis was calculated if there are arteriovenous blood flow in the pedicle or not.(3)There were 27 cases with of adnexal torsion with WS positive which the blood flow was evaluated inside and outside the pedicle.According to preoperative color Doppler ultrasound results,they were divided into four groups: group A(the arteriovenous blood flow can be detected inside and outside the pedicle),group B(only arterial blood flow in the pedicle + with blood flow outside the pedicle),group C(only arterial blood flow in the pedicle + without blood flow outside the pedicle),group D(blood flow loss inside and outside the pedicle).According to ovarian outcomes,they were divided into necrotic group and non-necrotic group.Calculate the predictive accuracy of ovarian necrosis was calculated if there are arteriovenous blood flow inside and outside the pedicle.Results:(1)There are 45 with adnexal torsion and 6 with adnexal nontorsion of the 51 patients with WS positive;There are 22 with adnexal torsion and 2231 with adnexal non-torsion of the 2253 patients with WS negative.The sensitivity of the WS to diagnose adnexal torsion is about 67.2%,the specificity is 99.7%,the diagnostic accuracy is 98.8%,the positive predictive value is 88.2%,the negative predictive value is 99%,and the ? is 0.757.(2)There were 45 cases of adnexal torsion with WS positive,of which there were 8 patients in group A(the arteriovenous blood flow in the pedicle),1 patient with ovarian necrosis and 7 patients without necrosis;there were 22 patients in group B(only arterial blood flow in the pedicle),10 patients with ovarian necrosis and 12 patients without necrosis;there were 15 cases in group C(blood flow loss in the pedicle),13 cases with ovarian necrosis,and 2 cases without necrosis.There was a correlation between the blood flow in the pedicle and ovarian necrosis(?2=12.726,P=0.001).When the arteriovenous blood flow in the pedicle was seen,the accuracy of ovarian non-necrosis was 87.5%.When there was no arteriovenous blood flow in the pedicle,the predictive accuracy of ovarian necrosis was 86.7%.(3)There were 27 cases with of adnexal torsion with WS positive which the blood flow was evaluated inside and outside the pedicle,of which there were 4 patients in group A(the arteriovenous blood flow can be detected inside and outside the pedicle),none of them with ovarian necrosis.There were 7 patients in group B(only arterial blood flow in the pedicle + with blood flow outside the pedicle),5 patients without ovarian necrosis,2 cases with ovarian necrosis;6 patients in group C(only arterial blood flow in the pedicle + without blood flow outside the pedicle),1 case without ovarian necrosis,5 cases with ovarian necrosis;There were 10 patients in group D(blood flow loss inside and outside the pedicle),all of them with ovarian necrosis.The accuracy of predicting ovarian non-necrosis was 100% when the arteriovenous blood flow can be detected inside and outside the pedicle;the accuracy of predicting ovarian necrosis when blood flow loss inside and outside the pedicle was 100%.Conclusions:(1)The ultrasound whirlpool sign has high specificity and accuracy to diagnosis adnexal torsion.(2)Color Doppler ultrasound combined with whirlpool sign has a high predictive accuracy to predict the ovarian necrosis.Add the blood flow evaluation outside the pedicle can improve the predictive value of ovarian necrosis. |
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