{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:46:15Z","timestamp":1790729175631,"version":"4.1.0"},"reference-count":64,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T00:00:00Z","timestamp":1604966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To describe the clinical and ultrasound characteristics of adnexal torsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study. From the operative records of the eight participating gynecological ultrasound centers, we identified patients with a surgically confirmed diagnosis of adnexal torsion, defined as surgical evidence of ovarian pedicle, paraovarian cyst and\/or Fallopian tube twisted on its own axis, who had undergone preoperative ultrasound examination by an experienced examiner, between 2008 and 2018. Only cases with at least two available ultrasound images and\/or videoclips (one grayscale and one with Doppler evaluation) were included. Clinical, ultrasound, surgical and histological information was retrieved from each patient's medical record and entered into an Excel file by the principal investigator at each center. In addition, two authors reviewed all available ultrasound images and videoclips of the twisted adnexa, with regard to the presence of four predefined ultrasound features reported to be characteristic of adnexal torsion: (1) ovarian stromal edema with or without peripherally displaced antral follicles, (2) the follicular ring sign, (3) the whirlpool sign and (4) absence of vascularization in the twisted organ.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 315 cases of adnexal torsion were identified. The median age of the patients was 30 (range, 1\u201388) years. Most patients were premenopausal (284\/314; 90.4%) and presented with acute or subacute pelvic pain (305\/315; 96.8%). The surgical approach was laparoscopic in 239\/312 (76.6%) patients and conservative surgery (untwisting with or without excision of a lesion) was performed in 149\/315 (47.3%) cases. According to the original ultrasound reports, the median largest diameter of the twisted organ was 83 (range, 30\u2013349) mm. Free fluid in the pouch of Douglas was detected in 196\/275 (71.3%) patients. Ovarian stromal edema with or without peripherally displaced antral follicles was reported in the original ultrasound report in 167\/241 (69.3%) patients, the whirlpool sign in 178\/226 (78.8%) patients, absent color Doppler signals in the twisted organ in 119\/269 (44.2%) patients and the follicular ring sign in 51\/134 (38.1%) patients. On retrospective review of images and videoclips, ovarian stromal edema with or without peripherally displaced antral follicles (201\/254; 79.1%) and the whirlpool sign (139\/153; 90.8%) were the most commonly detected features of adnexal torsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Most patients with surgically confirmed adnexal torsion are of reproductive age and present with acute or subacute pain. Common ultrasound signs are an enlarged adnexa, the whirlpool sign, ovarian stromal edema with or without peripherally displaced antral follicles and free fluid in the pelvis. The follicular ring sign and absence of Doppler signals in the twisted organ are slightly less common signs. Recognizing ultrasound signs of adnexal torsion is important so that the correct treatment, i.e. surgery without delay, can be offered. Copyright \u00a9 2020 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.21981","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T10:06:32Z","timestamp":1579860392000},"page":"934-943","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":101,"title":["Imaging in gynecological disease (20): clinical and ultrasound characteristics of adnexal torsion"],"prefix":"10.1002","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5070-7245","authenticated-orcid":false,"given":"F.","family":"Moro","sequence":"first","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Bolomini","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Sibal","sequence":"additional","affiliation":[{"name":"Department of Fetal Medicine and Obstetric and Gynecologic Ultrasound Manipal Hospital  Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. B.","family":"Vijayaraghavan","sequence":"additional","affiliation":[{"name":"Ultrasonic Scan Centre  Coimbatore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2513-274X","authenticated-orcid":false,"given":"P.","family":"Venkatesh","sequence":"additional","affiliation":[{"name":"Department of Fetal Medicine and OBGYN Ultrasound Manipal Hospital  Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Nardelli","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"},{"name":"Institute for Women's Health University College Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Pasciuto","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Mascilini","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3503-2451","authenticated-orcid":false,"given":"F.","family":"Pozzati","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"},{"name":"Istituto di Clinica Ostetrica e Ginecologica Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F. P. G.","family":"Leone","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Biomedical and Clinical Sciences Institute L. Sacco University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Josefsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Obstetrics and Gynecology S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2298-7785","authenticated-orcid":false,"given":"E.","family":"Epstein","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Obstetrics and Gynecology S\u00f6dersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1359-7155","authenticated-orcid":false,"given":"S.","family":"Guerriero","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato  Cagliari Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Scambia","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"},{"name":"Istituto di Clinica Ostetrica e Ginecologica Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3830-6414","authenticated-orcid":false,"given":"L.","family":"Valentin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital  Malm\u00f6 Sweden"},{"name":"Department of Clinical Sciences Malm\u00f6 Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. C.","family":"Testa","sequence":"additional","affiliation":[{"name":"Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Dipartimento Scienze della Salute della Donna, del Bambino e di Sanit\u00e0 Pubblica  Rome Italy"},{"name":"Istituto di Clinica Ostetrica e Ginecologica Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,11,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rcl.2014.07.008"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2016.03.042"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1067\/mem.2001.114303"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.18203\/2320-1770.ijrcog20180163"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.07.011"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2016.06.008"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2016.09.019"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2015.02.261"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2014.11.027"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2018.03.022"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2015.5490"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.14595"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2009.28.5.657"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.08.057"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000947"},{"key":"e_1_2_6_17_1","first-page":"252","article-title":"Isolated Torsion of the Hydrosalpinx in a Postmenopausal Woman","volume":"11","author":"Ding DC","year":"2007","journal-title":"JSLS"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-012-2304-8"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2004.01.037"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000250969.15438.17"},{"key":"e_1_2_6_21_1","first-page":"721","article-title":"Clinical risk factors for ovarian torsion","volume":"35","author":"Asfour V","year":"2015","journal-title":"J Obstet Gynaecol"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2010.02.006"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2011.08.722"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2009.02.028"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2010.10.020"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1447-0756.2008.00907.x"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1315186"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2006.05.091"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.154.3.3881798"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2013.09.010"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.2350\/12-07-1221-OA.1"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.2001.800111.x"},{"key":"e_1_2_6_33_1","first-page":"295","article-title":"Mashiach S, Oelsner G. Laparoscopy Versus Laparotomy for Detorsion and Sparing of Twisted Ischemic Adnexa","volume":"7","author":"Cohen SB","year":"2003","journal-title":"JSLS"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2007.26.10.1289"},{"key":"e_1_2_6_35_1","first-page":"55","volume-title":"Pathology of the ovary, fallopian tube and peritoneum","author":"Singh N","year":"2014"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2005.00728.x"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.10.053"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000995"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12542"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13256-018-1677-0"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2007.03.023"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003081-200609000-00006"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2010.03.020"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00287.x"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S7991"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpag.2007.11.003"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000160"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2011.30.9.1205"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.285075130"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2012.31.11.1803"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.7863\/ultra.32.9.1631"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7732"},{"key":"e_1_2_6_53_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2004.23.12.1643"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2008.27.1.7"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30837-4"},{"key":"e_1_2_6_56_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.1998.17.2.83"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00261-009-9573-0"},{"key":"e_1_2_6_58_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000621"},{"key":"e_1_2_6_59_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-011-1484-8"},{"key":"e_1_2_6_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-012-2304-8"},{"key":"e_1_2_6_61_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.163.6.7992751"},{"key":"e_1_2_6_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.20621"},{"key":"e_1_2_6_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7310"},{"key":"e_1_2_6_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0301-2115(02)00056-8"},{"key":"e_1_2_6_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-010-1702-z"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.21981","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21981","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/uog.21981","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.21981","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,28]],"date-time":"2023-08-28T02:58:24Z","timestamp":1693191504000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.21981"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,10]]},"references-count":64,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["10.1002\/uog.21981"],"URL":"https:\/\/doi.org\/10.1002\/uog.21981","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,10]]},"assertion":[{"value":"2019-09-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-14","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-11-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}