title: Analysis of Clinical and Ultrasound Determinants of Adnexal Torsion in Children and Adolescents.
abstract: OBJECTIVE
  We aimed to assess the performance of transabdominal ultrasonography (US) for diagnosis of adnexal torsion (AT) in children and adolescents and evaluate its clinical and US determinants. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We retrospectively (2004-2014) studied data for children referred for acute or subacute pelvic pain who underwent US and included children 3 months to 18 years old who underwent surgical exploration and/or clinical and radiological follow-up for at least 3 months. The evaluation of US diagnostic performance was on the basis of the proposed diagnosis after US: AT or no AT with or without mass. Clinical and US predictors of AT were identified using regression analysis.
  
  
  RESULTS
  Among 65 girls included (mean age 11.75 ± 4.49 years), 33 (50.8%) had AT. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of US for AT were 90.9%, 68.7%, 75%, 88%, and 80%, respectively. Overall, 20 of 33 (60.6%) AT patients had a mass, including 33% with mature teratomas. Patients with AT versus no AT more frequently showed vomiting (64% vs 28%; P = .008), ovarian edematous stroma with a peripheral distribution of follicles (45.5% vs 9.4%; P = .002) and a mass of pluritissular aspect (40% vs 0%; P < .0001). The quantitative US predictors of AT were total area ratio (ovary and mass)/area of the contralateral ovary 4.9 or greater (P = .0002) and surface area 18.5 cm2or greater (P = .0003).
  
  
  CONCLUSIONS
  US has high sensitivity but low specificity for the diagnosis of AT in children. The predictive criteria are vomiting, presence of a pluritissular mass, 4.9 area ratio or greater, or surface area 18.5 cm2or greater.
authors.affiliation: Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jourjon
authors.affiliation: Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Morel
authors.affiliation: Department of Surgery, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Irtan
authors.affiliation: Public Health Department, Hôpital Henri Mondor (AP-HP), Université Paris Est Créteil, Créteil, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Audureau
authors.affiliation: Department of Pathology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France.
authors.forename: Aurore
authors.initials: A
authors.lastname: Coulomb-L'Herminé
authors.affiliation: Department of Surgery, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France.
authors.forename: Michèle
authors.initials: M
authors.lastname: Larroquet
authors.affiliation: Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Ducou le Pointe
authors.affiliation: Department of Radiology, Hôpital Trousseau - Hôpitaux Universitaires de l'Est Parisien (AP-HP), Université Pierre et Marie Curie, Paris, France. Electronic address: eleonore.blondiaux@aphp.fr.
authors.forename: Eléonore
authors.initials: E
authors.lastname: Blondiaux
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D017699:Pelvic Pain / Q000209:etiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014102:Torsion Abnormality / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Adnexal torsion; Adolescents; Children; Hemorrhagic cyst; Ultrasound