Doppler studies of the ovarian venous blood flow in the diagnosis of adnexal torsion.

PURPOSE: To evaluate the role of ovarian Doppler studies in diagnosing adnexal torsion. METHODS: We included in that study all patients who had an adnexal mass with clinical symptoms of intermittent lower abdominal pain and were hospitalized for at least 48 hours of observation. Our protocol included: measurements of the size of the adnexal mass, presence or absence of ovarian edema, presence or absence of adnexal vascularity, presence or absence of ovarian artery flow, presence or absence of ovarian venous flow, pattern of ovarian venous flow. The ovarian artery and vein were sampled just above and lateral to the adnexa. Sensitivity, specificity, and positive and negative predictive values in the diagnosis of adnexal torsion were calculated for each of the gray-scale and Doppler sonographic (US) findings. RESULTS: One hundred and ninety-nine patients presented with adnexal mass and intermittent lower abdominal pain. Sensitivity and specificity of tissue edema, absence of intra-ovarian vascularity, absence of arterial flow, and absence or abnormal venous flow in the diagnosis of adnexal torsion were: 21% and 100%, 52% and 91%, 76% and 99%, and 100% and 97%, respectively. All patients with adnexal torsion had absent flow or abnormal flow pattern in the ovarian vein. In 13 patients, the only abnormality was absent or abnormal ovarian venous flow with normal gray-scale US appearance and normal arterial blood flow. Of these 13 patients, 8 (62%) had adnexal torsion or subtorsion. CONCLUSION: Abnormal ovarian venous flow may be the only abnormal US sign observed during the early stage of adnexal torsion.

A comparison between ultrasonography and hysteroscopy in the diagnosis of uterine pathology.

OBJECTIVE: To evaluate the diagnostic accuracy of transvaginal sonography (TVS) compared to hysteroscopy in diagnosing uterine abnormalities. In addition, to determine whether the number of diagnostic hysteroscopies can be reduced and replaced by TVS examinations. STUDY DESIGN: In this retrospective study, we summarized data from 128 patients who underwent TVS examination and hysteroscopy in our ultrasound unit during the last two years. Specimens were obtained and sent for histopathological examination. Sensitivity, specificity, positive and negative predictive values for diagnosing uterine pathology were calculated for each method. RESULTS: Hysteroscopy had a significantly higher sensitivity in diagnosing intra-uterine fibroids while TVS had a significantly higher sensitivity in diagnosing retained products of conception. Although hysteroscopy had better predictive values for diagnosing uterine polyps the difference was not statistically significant. The combination of both TVS and hysteroscopy did not seem to improve the sensitivity and specificity. There were three additional important findings: two cases of uterine hyperplasia and one case of endometrial carcinoma in patients with abnormal uterine bleeding were all diagnosed by hysteroscopy after being suspected on the TVS examination. CONCLUSION: TVS is an excellent tool in evaluating retained products of conception. In other cases of uterine pathology, diagnostic hysteroscopy is needed to improve diagnostic accuracy.