{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:49:54Z","timestamp":1780073394202,"version":"3.54.0"},"reference-count":9,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004358","name":"Samsung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004358","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004571","name":"Minist\u00e8re des Affaires Sociales et de la Sant\u00e9","doi-asserted-by":"publisher","award":["2021-0268_1"],"award-info":[{"award-number":["2021-0268_1"]}],"id":[{"id":"10.13039\/501100004571","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Nancy CHRU"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,2]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adnexal torsion is a gynaecological emergency in which prompt diagnosis and management are critical to preserving ovarian function. However, the clinical presentation is often non-specific, and diagnosis primarily relies on pelvic ultrasound, a modality with limited sensitivity that can lead to misdiagnosis and unnecessary surgery. Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging technique that may enhance diagnostic accuracy by better characterising adnexal vascularisation.<\/jats:p>\n                    <jats:p>The aim of this study is to assess whether the addition of CEUS to standard diagnostic procedures can reduce the rate of unnecessary emergency surgeries. Specifically, we compare two diagnostic strategies in cases of high clinical suspicion of adnexal torsion: the current standard approach versus an experimental strategy incorporating CEUS. The primary outcome is the rate of inappropriate surgical interventions, defined as emergency surgery performed within 6\u2009hours without intraoperative confirmation of torsion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This is a prospective, open-label, multicentre, randomised (1:1), controlled, superiority trial. A total of 256\u2009women presenting with a high clinical suspicion of adnexal torsion will be enrolled over a period of 36 months. Participants will be randomly assigned to either the standard diagnostic strategy or an experimental strategy that includes CEUS. The primary endpoint is the proportion of emergency surgical procedures (performed within 6\u2009hours of hospital admission) in which adnexal torsion is not confirmed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study was approved by the French Ethics Committee, the CPP (Comit\u00e9 de Protection des Personnes) on 28 October 2024. The results of this study will be published in peer-reviewed journals and presented at relevant national and international conferences. The ethical approval number from the CPP is 6115.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06677554\">NCT06677554<\/jats:ext-link>\n                      ; 2024-511720-13-00.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110352","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T05:10:25Z","timestamp":1772082625000},"page":"e110352","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Contribution of contrast-enhanced ultrasound for diagnosis of adnexal torsion (COVARIAN): protocol for a randomised controlled trial"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct06677554","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3547-9889","authenticated-orcid":false,"given":"Anne-Laure","family":"Fijean","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology, Nancy Regional University Hospital Center, Nancy, France"},{"name":"INSERM U1254, IADI, University of Lorraine, Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorine","family":"Manhertz","sequence":"additional","affiliation":[{"name":"INSERM U1254, IADI, University of Lorraine, Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Massicot","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Nancy Regional University Hospital Center, Nancy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise","family":"Lecointre","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Strasbourg University Hospitals Hautepierre Hospital, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Mottet","sequence":"additional","affiliation":[{"name":"Gyn\u00e9cologie-obst\u00e9trique, Centre Hospitalier Universitaire de Besancon, Besan\u00e7on, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Raimond","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Maison Blanche Hospital, Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Simon","sequence":"additional","affiliation":[{"name":"Obstetrics and Fetal Medicine, CHU Dijon, Dijon, 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